Insurance Verification/Authorization Speciali

Project Brilliance•West Palm Beach, FL

6h•$21 - $23

About The Position

The Insurance Verification/Authorization Specialist supports administrative workflows and clinical authorization tracking for an ABA therapy practice. The role helps secure reimbursement and maintain continuous client care by verifying insurance benefits and partnering with Board Certified Behavior Analysts (BCBAs) to ensure treatment authorizations are submitted, tracked, approved, and renewed without disruption. The specialist verifies client eligibility, benefits, out-of-pocket costs, and service-specific pre-authorization criteria; obtains initial authorizations; and investigates denials, prepares appeals, and reprocesses corrected claims. The role coordinates authorization deadlines and unit tracking with BCBAs, audits clinical plans and requests before submission, securely transmits clinical documentation to payors, monitors authorization decisions, and shares approval details with relevant teams. It also supports clinical appeals and peer-to-peer reviews, maintains electronic records and authorization logs, and provides general administrative support.

Requirements

High school diploma or equivalent.
At least 2–3 years of dedicated prior authorization, insurance verification, or front-end revenue cycle experience in an outpatient healthcare environment.
At least 1 year of direct experience handling authorizations and concurrent reviews in Applied Behavior Analysis (ABA).
Adhere strictly to HIPAA guidelines, medical documentation confidentiality requirements, and timely filing rules.
Working knowledge of prior authorization and appeals processes for commercial payors and web portals.
Proficiency with electronic practice management or billing software and Google Workspace, especially Google Sheets; ability to work in a Mac environment.
High accuracy when working with numbers, calculating billable hours, and auditing dates, authorization numbers, CPT codes, and requested clinical hours.
Clear, professional written and phone communication skills for interacting with insurance representatives and clinical staff.

Nice To Haves

Associate or bachelor’s degree in Healthcare Administration, Business, Psychology, or Behavioral Health.
Prior experience in an ABA, behavioral health, or therapy clinic setting.
Knowledge of Central Reach.
Experience with commercial payors such as United, Florida Blue, Aetna, Cigna, or Oscar.

Responsibilities

Contact insurance payors to verify active behavioral health benefits, out-of-pocket costs, and service-specific pre-authorization criteria.
Obtain initial authorizations for ABA services for new clients.
Investigate denial reasons, gather supporting clinical and administrative documentation, submit appeals, and reprocess corrected claims.
Track initial authorizations, concurrent reviews, re-authorizations, authorized units, and clinical report deadlines; notify BCBAs proactively about upcoming deadlines and expiring units.
Audit clinical treatment plans and authorization requests for accurate demographics, service dates, CPT/HCPCS codes, and requested hours before submission.
Securely submit BCBA clinical reports, treatment plans, assessments, and supporting medical records through payor portals or other secure channels.
Monitor payor portals for approvals, record approved units, service dates, and authorized codes in company systems, and share status updates with BCBAs, scheduling, and billing teams.
Partner with BCBAs to assemble documentation, schedule peer-to-peer physician reviews, and submit secondary appeals for denied or reduced therapy-hour requests.
Maintain organized electronic records, authorization logs, and client demographic data in practice management systems.
Keep contact lists, payor portal credentials, and billing and authorization reference guides up to date.
Provide general administrative support to the team on special projects as assigned.