Prior Authorization & Benefits Verification Specialist

COMPANY OVERVIEW At Bloomwell Autism Therapy, we help children with autism bloom and grow by providing high-quality ABA therapy in a nurturing and supportive environment. We are devoted and compassionate, multi-disciplinary group of clinicians that is creating a world where every child with autism gets the care and support they deserve. Energized by our mission to offer life-changing services to children and families affected by autism and unparalleled opportunities for our team across America, we are dedicated to advancing the state of autism care through best-in-class training, innovative treatment models and meaningful outcomes measurement.POSITION OVERVIEWLocation: Work From HomeWork Schedule:Monday to Friday, 8:00 AM – 5:00 PM CST | 9:00 PM - 6:00 AM MNLHolidays: U.S. HolidaysKEY RESPONSIBILITIES Prior AuthorizationCollect and organize clinical documentation required to support prior authorization (PA)requests, including assessment reports, treatment plans, and physician orders.Submit PA requests to commercial insurers, Medicaid managed care organizations, and state Medicaid programs across all operating states.Monitor authorization status and proactively follow up with payers to ensure timely approvals.Track authorization end dates and initiate re-authorization requests well in advance ofexpiration.Maintain accurate records of authorization numbers, approved units, service codes, and effective dates in the EMR and relevant tracking systems.Communicate PA status updates to clinical and scheduling teams to prevent service disruptions.Appeal denied or insufficient authorizations in coordination with clinical staff and leadership.Benefits Verification & EligibilityConduct thorough insurance eligibility and benefits verification for all new patient inquiries, including coverage type, deductibles, copays, coinsurance, out-of-pocket maximums, and ABA-specific benefit limitations.Verify active coverage and eligibility at intake and on an ongoing basis for existing patients.Accurately document benefit details in the EMR and communicate findings to the care coordination and billing teams.Identify and flag patients with coverage gaps, coverage changes, or secondary insurance considerations.Documentation & ComplianceMaintain organized, complete, and audit-ready records for all authorization and eligibility activities.Follow payer-specific documentation requirements and stay current on policy changes across all contracted health plans.Support internal audits and payer audits by providing requested documentation in a timely manner.Adhere to HIPAA and all applicable state and federal regulations governing protected health information.Cross-Functional & Special Projects· Contribute to operational improvement initiatives, including workflow redesigns, system implementations, and process documentation projects.· Support onboarding of new clinic locations by helping establish payer credentialing and PA workflows in new markets.· Assist leadership with ad hoc research, reporting, and analysis related to payer policy, authorization trends, or operational performance.· Collaborate cross-functionally with clinical, scheduling, billing, and leadership teams as needed.CANDIDATE PROFILE NICE TO HAVESExperience with ABA therapy, behavioral health, or pediatric services.Multi-state insurance experience, particularly in Medicaid or Medicaid managed care environments.Experience working in a high-growth or multi-site healthcare organization.QUALIFICATIONS2+ years of experience in prior authorization, benefits verification, or a closely related healthcare revenue cycle role.Demonstrated knowledge of commercial insurance and Medicaid payer processes, including authorization workflows and eligibility verification.Strong organizational skills with the ability to manage a high volume of tasks with competing deadlines.Proficiency with EMR/EHR platforms and payer portals.Excellent written and verbal communication skills.High attention to detail and commitment to documentation accuracy.Originally posted on Himalayas