Authorization Manager

Already Autism Health is seeking an experienced Authorization Manager to oversee and manage all aspects of prior authorization processes for Applied Behavior Analysis (ABA) therapy and testing services. This critical role ensures timely authorization approvals, maintains compliance with insurance regulations, and optimizes revenue cycle performance through efficient authorization workflows.
MUST RESIDE IN CHARLOTTE, NC

• Manage and oversee the prior authorization department, including staff supervision, training, and performance evaluation
• Develop, implement, and optimize prior authorization workflows to ensure efficiency and accuracy
• Maintain current knowledge of insurance policies, regulations, and requirements specific to autism services to ensure compliance with industry standards
• Review patient medical records and insurance information to determine which ABA services require authorization
• Coordinate with healthcare providers, insurance companies, and Quality Improvement Organizations (QIOs) to obtain pre-authorization for ABA therapy, behavioral assessments, and related treatments
• Monitor and track authorization requests to ensure timely approvals and minimize service delays
• Communicate proactively with patients, families, and healthcare providers regarding the status of authorization requests and any changes in coverage
• Perform department audits to identify authorization errors and implement corrective action plans
• Report essential KPIs to senior leadership to ensure departmental goals are being met
• Collaborate with clinical, operational, and revenue cycle teams to develop automated, repeatable processes
• Ensure compliance with HIPAA, Medicaid, and third-party payor regulations
• Manage relationships with extended department vendors and payer portals
• Develop and update policies and procedures related to authorization processes
• Lead business process improvement efforts to optimize revenue collection and reduce authorization denials.
• Provide direct oversight ensuring workflows and processes are completed accurately and efficiently

• Minimum 5 years of experience in healthcare authorization, with at least 2 years in a supervisory or management role
• Strong knowledge of autism spectrum disorder services, particularly Applied Behavior Analysis (ABA) therapy authorization requirements
• Experience with insurance verification, eligibility determination, and prior authorization processes
• Demonstrated expertise with payer portals and automated authorization tools
• Thorough understanding of insurance policies, coverage requirements, and authorization criteria
• Knowledge of HIPAA regulations and healthcare compliance standards
• Proven ability to manage and develop staff effectively
• Strong analytical skills with ability to interpret data and identify trends
• Excellent communication and interpersonal skills for interacting with patients, families, providers, and insurance representatives
• Proficiency with electronic health records (EHR) and revenue cycle management software
• Strong organizational and time management abilities.

• Bachelor's degree in Healthcare Administration, Business Administration, or related field
• Experience specifically with autism healthcare services or behavioral health
• Knowledge of state-specific autism insurance mandates and Medicaid waivers programs
• Experience with quality improvement initiatives and process optimization
• Familiarity with coding and billing for ABA services
• Central Reach EMR experience highly preferred

• Leadership and team development
• Strategic thinking and problem-solving
• Attention to detail and accuracy
• Customer service orientation
• Adaptability and flexibility
• Results-driven mindset

• Paid Time Off (PTO)
• 401K Retirement Plan
• Medical, Dental and Vision
• Health Savings Accounts
• Short-Term and Long-Term Disability Benefits
• Supplemental Life Insurance with Accidental Death and Dismemberment Insurance

Job Type: Salaried

We are an equal opportunity employer and prohibit discrimination/harassment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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