Senior Authorization Specialist - Healthcare Autism Therapy Provider - Mooresville NC Corporate Support Center

Highlights Healthcare is seeking a passionate and dedicated Senior Authorization Specialist to join our corporate support team. Our team supports our ABA therapy Learning Centers and diagnostic clinicians throughout the southeast.

Who is Highlights Healthcare?

Highlights Healthcare provides diagnosis and early intervention ABA therapy services to bring meaningful and positive change to children with autism. We specialize in serving young learners and families with Medicaid benefits. We believe every child can achieve great things, and we are guided by family-centered principles that demonstrate dignity and respect.

Why you should consider a position with Highlights:

• Competitive pay, commensurate with experience

• Full time employment

• Benefits include Paid Time Off (PTO), Health, Dental, and Vision Insurance, Employee Assistance Program (EAP), Flexible Spending Account (FSA), Health Savings Account (HSA)

• Supportive/collaborative work environment

• Growing company committed to clinical excellence and its mission

Job Summary

An Authorization Specialist Senior is a healthcare administrative professional responsible for securing approval from insurance providers before a patient receives specific medical services, procedures, or medications. They act as a liaison between physicians, insurance companies, and patients to ensure treatments are covered and to prevent denied claims.

Essential Job Functions

• Authorization Procurement: Initiate, track, and obtain prior authorizations from third-party and government payers via telephone, fax, or online provider portals.
• Clinical Documentation Review: Review medical records, physician orders, and notes to ensure they support the medical necessity required by insurers.
• Insurance Verification: Verify patient insurance eligibility, benefits, and coverage limitations to ensure accurate billing.
• Communication & Liaison: Contact patients to inform them of approval/denial status and deductibles; coordinate with physician offices for additional clinical information.
• Documentation & Data Entry: Maintain accurate, detailed notes in Electronic Health Records (EHR) or Electronic Medical Records (EMR) systems like Central Reach.
• Denial Management: Appeal denied authorizations requests by analyzing the root cause, gathering additional documentation, and resubmitting requests.
• Workflow Optimization: Prioritize urgent/STAT requests and ensure all authorizations are secured before scheduled appointments to prevent delays in care.

Requirements:

• Experience: Generally requires 1–2 years of experience in medical billing, insurance verification, or a related healthcare clerical role.
• Medical Knowledge: Familiarity with medical terminology, ICD-10 diagnosis codes, and HCPCS/CPT codes.
• Technical Skills: Proficiency in MS Office (Excel, Word) and experience with EMR/Practice Management software.
• Soft Skills: Strong attention to detail, excellent communication skills (written and verbal), critical thinking, and the ability to work under pressure.
• Education: High school diploma or GED is usually required; an associate degree in health information management or medical coding is preferred.

Additional Responsibilities:

• Perform general office duties to support Highlights Healthcare daily operations.
• Suggest improvements and changes to processes and policies to improve productivity or customer satisfaction.
• Maintain industry knowledge to keep skills current and to develop professionally.
• Comply with Highlights Healthcare's vision, mission, and values.
• May be required to be available afterhours which includes evenings, weekends, and holidays.

The above tasks reflect the essential functions and other job functions considered necessary for the job identified, and shall not be construed as a detailed description of all work requirements that may be inherent in the job, or assigned by supervisory personnel.  The job description is used as a guide only and not inclusive of responsibilities and job duties.

Highlights Healthcare is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. In addition to federal law requirements, Highlights Healthcare complies with applicable state and local laws governing nondiscrimination in employment. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

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