Insurance Authorization Specialist

Job Description

Job Description

Company Overview
PlayDate Behavioral Interventions is a dedicated nonprofit organization committed to providing comprehensive applied behavioral interventions to children with disabilities. Our services include Applied Behavior Analysis (ABA) Therapy, Community Connector programs, Educational Placement, and Respite Care, all aimed at supporting children’s development and enhancing their quality of life.

Job Summary
We are seeking a detail-oriented and proactive Prior Authorization Specialist to join our team. The ideal candidate will possess strong knowledge of managed care processes, medical office procedures, and healthcare regulations. In this role, you will be responsible for managing prior authorization requests, verifying insurance coverage, and ensuring timely approval of services to facilitate seamless care delivery for our clients. Your expertise will help streamline administrative workflows and support our mission of delivering high-quality interventions to children with special needs.

Duties

• Review and process prior authorization requests for various behavioral health and medical services in accordance with insurance guidelines.

• Verify insurance coverage and benefits for clients by conducting thorough insurance verification procedures.

• Collaborate with healthcare providers, families, and insurance companies to gather necessary documentation and ensure compliance with all regulations.

• Maintain accurate medical records related to authorization requests while adhering to HIPAA (Health Insurance Portability and Accountability Act) standards for confidentiality.

• Utilize CPT (Current Procedural Terminology), ICD-9, ICD-10, and ICD coding systems to accurately document diagnoses and procedures in authorization submissions.

• Track the status of pending authorizations and follow up proactively to expedite approvals or address denials promptly.

• Stay informed about changes in managed care policies, insurance requirements, and healthcare regulations affecting prior authorization processes.

Requirements

• Proven experience in managed care environments or medical office settings with a focus on prior authorization procedures.

• Strong knowledge of medical terminology, medical records management, and medical coding systems including CPT, ICD-9, ICD-10, and ICD coding.

• Familiarity with HIPAA regulations to ensure patient confidentiality and data security.

• Experience with insurance verification processes across various healthcare plans.

• Previous dental office or medical office experience is preferred but not required.

• Excellent organizational skills with the ability to manage multiple cases efficiently under tight deadlines.

• Effective communication skills for liaising between providers, insurance companies, and families. Join our team as a Prior Authorization Specialist to play a vital role in facilitating access to essential services for children with disabilities while advancing your career within a compassionate healthcare environment.

Benefits:

• Dental insurance

• Health insurance

• Health savings account

• Life insurance

• Paid time off

• Retirement plan

• Vision insurance

Experience:

• Prior Auth: 2 years (Required)

• Medical billing: 2 years (Preferred)