Prior Authorization Specialist

About the Role

This growing provider network offers tailored Applied Behavior Analysis therapy for children experiencing developmental delays and autism spectrum disorder. The organization links families with independent, local clinicians through versatile care models that integrate into everyday life. With support for diagnostics and a network spanning more than 100 insurance payers, the company is essential for helping children access required services. This early-stage business is seeking a Prior Authorization Specialist to manage the authorization lifecycle and support a function vital to patient care access. You will act as a primary team member by handling intricate cases and complex payer specifications. By focusing on operational quality, you will support favorable patient results while collaborating with a high-achieving team in an energetic setting. This position offers a chance to refine intake procedures and provide clear support to families during their clinical experience.

Requirements

• You should possess at least five years of experience in ABA intake, preferably with a background focused on prior authorizations.
• Direct, proven experience handling TRICARE authorizations, including ECHO enrollment processes, is required.
• You must demonstrate strong organizational skills and excellent follow-through.
• You should be a clear, confident communicator capable of interacting effectively with clinical staff, families, and referring doctors.
• You need to show superior problem-solving skills and the ability to make logical decisions in ambiguous situations.
• You must maintain a supportive and accessible attitude while adhering to rigorous professional standards.

Responsibilities

• You will oversee the complete authorization lifecycle for complicated cases, focusing on TRICARE procedures and ECHO enrollment steps.
• Your tasks involve handling escalations from the authorization provider, fixing rejected authorizations, and managing diverse payer guidelines.
• You will work with billing and insurance staff to identify and correct issues while facilitating clear, prompt communication between medical teams, BCBAs, and families.
• You will inform families about required documentation, expected timelines, and future steps, specifically when dealing with escalated or urgent situations.
• Outside of daily case handling, you will detect intake bottlenecks and manage process improvement projects from conception to completion while keeping accurate system records.

Benefits & Perks

• You will have the chance to significantly accelerate how fast families secure necessary care through high-level operational efficiency.
• You will hold an impactful position within an early-stage, rapidly expanding company and collaborate with talented professionals in the ABA sector.