Verification and Authorization Specialist

Forge Health•White Plains, NY

About The Position

Forge Health is a mission-driven outpatient mental health and substance use provider dedicated to providing the highest quality, affordable, and effective care to individuals, families, and communities in need. As the first and only behavioral healthcare provider with a proven, national payer-validated ability to drive clinical outcomes that span all areas of health, Forge Health is leading the charge in driving innovation, improving care delivery, and shaping the future of behavioral health care. At Forge, clinical care is paramount – it’s the heartbeat of our operations and the driving force in everything we do. The skill and compassion of our staff are the crucial components to extraordinary experiences and outcomes for those we serve. With our current clinical footprint in the greater Northeast, we have offices in New York, New Jersey, Pennsylvania, New Hampshire – and we’re growing! Come join us! We are seeking a detail-oriented and customer-focused Verification and Authorization Specialist with strong payer knowledge and excellent communication skills. The ideal candidate is experienced at verifying coverage and benefits, navigating multiple payer portals, and obtaining prior authorizations. A collaborative approach to working with clinical teams and a commitment to timely, professional communication with clients and staff are essential.

Requirements

3+ years of Insurance Verification and Authorization experience, preferably within a behavioral/mental health setting.
Bachelor’s degree required.
Proficiency with electronic health record (EHR) and billing software.
Extremely detail-oriented with excellent analytical, problem-solving, and organizational skills.
Ability to keep confidential medical records of patients.
Works well in groups as well as individually, with minimal supervision.

Responsibilities

Verify clients’ insurance coverage and benefits to confirm service eligibility and determine out-of-pocket costs.
Spend extensive time on the phone with insurance companies to confirm benefits, service limits, and authorization requirements.
Access and navigate multiple payer portals (e.g., Availity, Optum, Aetna, Cigna) to verify benefits, submit authorizations, upload supporting documentation, and track approval statuses.
Document detailed benefit information, including co-pays, deductibles, visit limits, covered services, and restrictions.
Obtain and manage prior authorizations for services as required by payers, ensuring all relevant CPT codes, units, and service lines are accurately submitted.
Track and monitor authorizations for approved visits, expiration dates, and required renewals to prevent disruptions in client care.
Follow up with insurance carriers regularly to confirm receipt and approval of pending authorizations.
Collaborate with clinical staff and management to gather clinical documentation or treatment information necessary for authorization requests.
Maintain precise, timely documentation of all interactions with insurance carriers in the electronic health record (EHR).
Ensure strict confidentiality of client information in compliance with HIPAA and organizational policies.
Provide professional and timely communication to clients and staff to support excellent customer service.

Benefits

Competitive salary aligned with your experience
Comprehensive paid time off package
Annual time off to volunteer
Parental leave
Annual continuing education allocations
Competitive medical, dental, and vision package
Annual subscription to a leading meditation app
An environment that fosters professional development including financing for advanced licensure and certifications
Internal supervision opportunities
Dedicated, motivated team and chance to be part of a highly ambitious medical startup
Modern, elegant, and high-end work environment