Patient Eligibility - Authorizations Specialist (Care Readiness)

Behavioral Innovations • Addison, TX

103d

About The Position

Join our fast-growing behavioral health company and play a key role to help prospective and existing clients with Insurance Authorizations! As a key member of the BI team, the Patient Eligibility and Authorization Specialist is responsible for verifying patient insurance eligibility and benefits and obtaining pre-authorizations for outpatient services, specifically for ABA, in accordance with insurance carrier requirements. This role is critical in ensuring proper and timely documentation, tracking, and communication of client authorizations. The specialist works closely with clinical teams, area and regional leadership, insurance providers, the intake team, and billing personnel. Strong communication skills are essential for successful collaboration and resolution of insurance related issues. A thorough understanding of insurance payor guidelines, eligibility requirements, and authorization processes is required. The role requires proactive communication via phone and email with commercial, Medicaid, and managed care payors, and escalations to leadership when necessary.

Requirements

• Bachelor’s degree preferred.
• 3–5 years of experience in clinical operations, insurance verification, or authorization within a behavioral health or medical setting preferred.
• Excellent written and verbal communication skills with a strong focus on collaboration and customer service.
• Ability to manage multiple priorities in a fast-paced environment with strong attention to detail.
• Proficiency in Electronic Medical Records (EMR), CRM systems, and insurance portals.
• Proven problem-solving skills and initiative.
• Ability to maintain confidentiality and adhere to HIPAA standards.
• Must uphold BI’s core values and mission in all professional interactions.

Responsibilities

• Maintain working knowledge of major commercial and government insurance payors and their guidelines.
• Verify insurance eligibility and benefits for all services provided by Behavioral Innovations (BI).
• Mentor Authorization Specialists by sharing best practices and training on authorization workflows.
• Manage submissions and follow-up for assessments, initial service authorizations, and re-authorizations.
• Ensure accurate documentation of authorization activities in both CRM and EHR systems.
• Communicate with payors to resolve pending or denied authorizations and provide timely updates to internal stakeholders.
• Track and monitor authorization thresholds to prevent lapses in coverage and service interruptions.
• Collaborate with clinicians to coordinate re-authorizations ahead of expiration dates.
• Work with the intake team to resolve paperwork issues that could delay assessments or initial authorizations.
• Identify and escalate trends in authorization denials, contributing to staff training and process improvements.
• Assist clinical teams in ensuring that documentation aligns with payor requirements for clean submissions.
• Navigate and utilize Electronic Medical Records (EMR) and billing systems effectively.
• Maintain positive relationships with internal teams and external payors to support efficient authorization processes.
• Perform other related duties as assigned.

Benefits

• Competitive Hourly rate
• 10 days PTO, 7 paid holidays
• Medical, Vision, Dental, and Supplemental Plans
• Tools and programs to support physical, mental, and emotional wellness
• Comprehensive support through Employee Assistance Program (EAP)
• Caring, collaborative environment
• Recognized for clinical excellence and ethical standards
• Help children with autism reach their full potential

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Bachelor's degree
• Number of Employees: 1,001-5,000 employees