Qualifications

• 5+ years experience in ABA intake with a focus on Prior Authorizations or Insurance Certification
• Strong understanding of ABA pre-certification processes for Tricare East, Medicaid MCOs, BCBS State plans, Aetna, and/or Cigna
• Highly organized with a relentless focus on follow-through
• Extreme attention to detail, able to analyze complex clinical documents and payor feedback
• Clear and confident communicator with diverse stakeholders
• Proactive problem-solver, skilled at identifying and fixing issues
• Comfortable making judgment calls amid ambiguity

Responsibilities

• Collaborate with the Prior Authorizations vendor to resolve complex authorization issues with providers, patients, and payors
• Serve as the in-house expert on prior authorizations and pre-certification for specific regions or payors
• Assist the team in securing documentation and resolving authorization rejections
• Identify bottlenecks and inefficiencies in the intake workflow alongside operations team
• Create processes and training materials for offshore team members on prior authorization issues
• Manage Prior Authorization outcomes and KPIs for your assigned region and payors

Benefits

• Chance to significantly influence health outcomes for vulnerable populations
• Rapid career growth opportunities as a new function is established
• Join a rapidly growing healthcare startup with 30% - 50% monthly growth
• Work with a high-performing team leveraging technology to build a scalable digital health platform