Authorization Specialist

Therapy-and-Beyon; Flower Mound (TX); On-site; USD 42,000 - 64,000; Full time

Benefits offered by this job

Medical, Dental, Vision

401K with company match

HSA and FSA options

Employee Assistance Program

Life Insurance

Job summary

Therapy & Beyond is seeking an Authorization Specialist to manage pre-authorizations, retroactive approvals, and ongoing authorizations. You will liaise with payors and clinical staff to minimize denials and ensure timely reimbursement.

You will mentor teammates, follow up on activities per payor schedules, and maintain documentation accuracy within the practice management system.

Qualifications

• Minimum 2 years in insurance verification, medical billing, or authorization management.
• Proficiency with EMR systems and payor portals.
• Strong written and verbal communication skills with attention to detail.

Responsibilities

• Initiate and secure initial benefits, pre-authorizations, and re-authorizations via payor portals, fax, or telephone.
• Mentor and oversee team members on authorization processes and payor requirements.
• Follow-up according to payor guidelines to expedite claims and minimize revenue loss.
• Resolve complex cases including retroactive authorizations and SCAs for out-of-network patients.
• Coordinate with healthcare providers to obtain needed clinical notes and documentation.

Skills

Communication skills

Detail-oriented

Organization

Education

Associate degree

Bachelor's degree

Tools

EMR systems

Payor portals

Job description

Therapy & Beyond is one of the largest BCBA-owned ABA organizations, founded and led by Dr. Regina Crone, BCBA-D, since 2006. At Therapy & Beyond we approach the needs of each patient both individually and as part of a dynamic interdisciplinary team working with experts in applied behavior analysis (ABA) therapy, speech-language pathology, occupational therapy, and counseling. We love helping individuals reach their full potential by supporting not only the patient but also their family. We are passionate about what we do while remaining true to our defining core values of:Putting People First,Doing Our Best Together,Making Therapy Fun, and Above All, We grow potential

Job Description

At Therapy & Beyond, we are passionate about empowering families and guiding our clients toward success! As an Authorization Specialist, you will play a vital role in our mission by managing the full lifecycle of insurance verification and authorization. In this key role, you’ll help ensure seamless financial reimbursement by securing pre-authorizations, obtaining retroactive approvals, and maintaining active authorizations for ongoing care. Serving as a trusted liaison between our organization, third-party payors, and dedicated clinical team, you will help minimize denials so our staff can focus on what matters most: delivering exceptional care.

JOB-SPECIFIC FUNCTIONS:

Team Mentoring & Oversight: Provide guidance and support to team members on authorization processes, best practices, and payor requirements.

Authorization Management: Initiate and secure initial benefits, pre-authorizations, and re-authorizations via payor portals, fax, or telephone.

Follow-Up & Tracking: Strictly adhere to follow-up schedules (e.g., 3, 7, 14, 30 days) based on payor guidelines to expedite claims and prevent revenue loss.

Complex Case Resolution: Manage high-complexity requests, including retroactive authorizations and Single Case Agreements (SCAs) for out-of-network patients.

Data Integrity: Verify that authorization quantities, CPT codes, and effective dates are accurately entered into the practice management system.

Clinical Collaboration: Coordinate directly with healthcare providers to secure necessary clinical notes, letters of medical necessity, and supporting documentation in a timely manner.

Process Improvement: Develop and maintain a centralized "Payor Master List" and internal authorization manuals to standardize workflows and improve efficiency.

Compliance: Review and interpret insurance group pre-certification requirements to ensure full compliance before services are rendered.

Qualifications

Education: Associate’s of Bachelor's degree preferred in Healthcare Administration or related field preferred.

Experience: Minimum of 2 years of experience in insurance verification, medical billing, or authorization management.

Technical Skills: Proficiency with electronic medical records (EMR) systems, and payor portals.

• Soft Skills: Strong written and verbal communication skills with the ability to build rapport with insurance representatives. Excellent organizational skills and attention to detail.

Additional Information

• Medical, Dental, Vision, and Disability
• Company Paid- Life Insurance
• 401K with company match
• Company Paid Short-Term Disability
• HSA and FSA options
• Employee Assistance Program
• Employee Recognition