Prior Authorization Specialist

Thrive Autism Services is a specialty agency for children with autism spectrum disorder, with both in-clinic and in-home services. We service clients with behavior, cognitive, developmental needs from 18 months into adulthood. We offer caring ABA therapy centered around the client’s voice and experience. Our mission is to create a healthy and safe environment for all individuals living with Autism to learn, grow and THRIVE. We take pride in knowing that we make a difference in a person’s life each day. Job Description: Prior Authorization Specialist Company: Thrive Autism Services Location: (In-Person/Hybrid) Department: Billing Department Reports to Billing Manager Position Overview Prior Authorization Specialist manages the crucial intersection of clinical authorizations and weekly revenue generation for Applied Behavior Analysis (ABA) therapy. In this role, you will secure and maintain insurance authorizations, scrub and submit clean claims weekly, and resolve any current AR denials, ensuring that Thrive Autism Services receives accurate, timely reimbursement for our life-changing services. Key Responsibilities Review, scrub, and audit all weekly ABA therapy encounters to ensure compliance with payer-specific documentation guidelines. Verify accuracy of CPT codes, modifiers, and clinician signatures before electronic submission. Submit all clean claims on a strict weekly schedule to maximize consistent cash flow. Submit initial prior-authorization requests for ABA therapy to government (Medicaid) and commercial insurance carriers. Verify patient insurance eligibility, benefits, and coverage limitations. Track and manage authorization expiration dates, proactively securing re-authorizations to prevent gaps in treatment. Coordinate with clinical staff (BCBAs) to obtain necessary medical documentation and progress reports for peer-to-peer reviews and appeals. Current Accounts Receivable (AR) Management Monitor current AR aging on a weekly basis to address and resolve recent unpaid or rejected claims immediately. Investigate underpaid, denied, or unacknowledged claims to determine the root cause and execute corrective actions. Prepare and submit formal appeals for newly denied claims with appropriate clinical documentation. Act as the primary liaison with insurance representatives to secure Single Case Agreements (SCAs) for out-of-network benefits. Communicate clearly with families to explain billing statements, insurance benefits, and current balances. Help parents/guardians understand their financial responsibility and address any billing questions. Handling patient billing through QuickBooks. Qualifications & Requirements Experience: 1–3 years of medical billing, claims preparation, authorization experience. Previous experience with ABA therapy is highly preferred. Insurance knowledge, AHCCCS (Arizona Medicaid) and DDD (Division of Developmental Disabilities) knowledge: These are vital for Arizona ABA billing. Commercial Payers: Familiarity with regional portals like Blue Cross Blue Shield of Arizona, Banner Health and Aetna. Skills: Exceptional attention to detail for scrubbing claims and a thorough understanding of insurance billing guidelines, CPT codes, and the appeals process. Must be able to effectively manage time and meet deadlines. Tech Skills: Proficiency in medical billing software and Electronic Health Record (EHR) systems. Prior experience with Tebra and Rethink is preferred. Compliance: Strict adherence to HIPAA guidelines and ability to safeguard protected health information (PHI). This job is a hybrid position that will involve regular presence in the central office in North Phoenix. Pay Range

$24 - $26 USD

Joining our team means that you are part of a passionate team of professionals dedicated to meeting the needs of our clients. Thrive Autism is committed to diversity, inclusion, and belonging. We strive to create an environment where everyone feels valued and supported, regardless of their background or identity. #J-18808-Ljbffr Thrive Autism Services