Authorizations & Payor Navigation Specialist

Kind Behavioral Health is a leading provider of Applied Behavior Analysis services in North Carolina and Georgia, dedicated to improving the lives of children with autism spectrum disorder (“ASD”). We provide life-changing treatment to children with ASD, providing outstanding quality care, and delivering exceptional clinical outcomes, in an environment in which all are encouraged to THINK BIG, HAVE FUN, DO GOOD, and BE KIND. We deliver treatment through individualized care plans, and target socially significant behaviors, enabling the clients we serve to lead more independent, fulfilling lives. The Authorizations Specialist supports the timely access to medically necessary services by coordinating and managing authorization processes across contracted commercial and government (Medicaid/Tricare) payors. Reporting to the Manager, Revenue Cycle Operations, this role partners with Licensed Board Certified Behavior Analysts (BCBAs), Licensed Psychologist, Licensed Psychological Associates, third‑party vendors, and internal revenue cycle team members to ensure accurate submission, tracking, and follow through on authorization requirements. This role serves as an operational resource that helps translate payor requirements into clear, actionable guidance, supports appeals processes, and assists in minimizing service disruptions by proactively monitoring authorization timelines. The position contributes to revenue integrity and continuity of care while advocating for medically necessary services on behalf of the clients and families we serve. Role Responsibilities Clinician Partnership & Insurance Support Serve as a resource to clinicians regarding payor‑specific requirements, timelines, and documentation expectations. Provide structured guidance and tools to support accurate authorization submissions. Communicate upcoming authorization expirations, authorization requirements and help clinicians navigate the authorizations process. Assist clinicians in understanding authorization determinations, including denials, and appeal processes. Translate insurance requirements into clear, practical guidance for clinical teams. Authorization Submission & Coordination Coordinate submission of initial authorizations and reauthorizations through designated authorization platforms. Review submitted documentation for completeness and alignment with payor requirements prior to submission. Track authorization requests from submission through determination. Follow up with payors as needed to obtain updates or clarify requirements. Enter authorization details into practice management systems accurately and timely. Maintain organized and audit‑ready records of authorization activity. Re‑Authorization Monitoring & Revenue Support Monitor authorization expiration timelines and assist in coordinating timely re‑submissions. Escalate potential risks related to authorization delays or lapses to the Manager, Revenue Cycle Operations or appropriate stakeholders. Collaborate with intake, scheduling, and billing teams to support alignment between authorizations and service delivery. Support efforts to minimize preventable authorization‑related service disruptions or billing challenges. Payor Navigation & Appeals Support Maintain working knowledge of commercial and government payor policies and authorization processes. Assist with preparation and submission of appeals for partial or full denials under direction of leadership or clinical partners. Communicate professionally with payor representatives and utilization management teams. Support advocacy efforts aligned with clinical recommendations and organizational standards. Process Support & Cross‑Functional Collaboration Identify recurring challenges within authorization workflows and communicate opportunities for improvement to leadership. Maintain internal documentation related to authorization processes and payor requirements. Participate in tracking and reporting activities related to authorization timeliness and outcomes. Role Requirements High school diploma AND 2+ years experience supporting healthcare insurance authorizations, utilization management workflows, revenue cycle operations, or related roles such as intake coordination, utilization review support, medical billing/AR follow‑up, or therapy service authorization coordination - OR Bachelor’s degree in Healthcare Administration, Business, Behavioral Health, or related field AND 1+ years foundational experience in healthcare operations, insurance authorization processes, or payor interaction. Strong organizational skills with the ability to manage multiple deadlines and track complex workflow - required. Effective written and verbal communication skills; ability to translate complex payor requirements into practical guidance - required. Experience coordinating healthcare authorization submissions or tracking authorization workflows - required. Experience working with commercial and/or government payors (Medicaid, Tricare, commercial insurers) - required. Proficiency in Microsoft Office Suite (Excel, Word, Outlook) - required. Experience using collaboration tools such as SharePoint, OneDrive, and Microsoft Teams - required. Experience supporting ABA services, behavioral health programs, or therapy‑based authorization workflows - preferred. Experience interpreting payor policies or authorization criteria - preferred. Experience with practice management systems (e.g., CentralReach) - preferred. Experience supporting authorization appeals or ordinal follow‑up - preferred. KBH is committed to creating a diverse environment and we are proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. Diversity is more than a commitment at KBH—it is the foundation of what we do, adhering to the highest professional standards while creating an environment in which exceptional people (like you!) can think big, have fun, do good, and be kind. #J-18808-Ljbffr Kind Behavioral Health