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Authorization Specialist (ABA Services | USA Healthcare) - EST Hours (Remote)

1 hour, 31 minutes ago
South Africa
Full-time
Junior
Operations Specialist
Customer and Technical Support
CRM
Apply Now
ISTA Solutions

ISTA Solutions

ISTA Solutions is a one-stop outsourcing company that provides quality and cost-efficient services and solutions. They offer tailor-made workflow solutions, skilled agents dedicated to clients, global resources for comprehensive support, and a focus on...

Professional Services
251-1K
Founded 2015
View All Jobs 13

Description

  • Verify patient insurance eligibility and ABA benefits using Availity and CentralReach for commercial and Medicaid payers.
  • Submit initial authorization requests and reauthorization requests for ABA therapy services.
  • Monitor authorization statuses, approved hours, visit limits, and expiration dates.
  • Follow up with insurance providers regarding pending, denied, or incomplete authorizations.
  • Work with Intake, Scheduling, Clinical, and Billing teams to maintain continuity of care.
  • Obtain, upload, and manage clinical documentation required for authorization submissions.
  • Maintain accurate records and updates in CRM and EHR systems.
  • Assist with appeals, denied claims, and authorization discrepancy resolutions.
  • Communicate professionally with families about insurance requirements and authorization updates.
  • Generate reports and maintain spreadsheets for authorization approvals, renewals, and related tracking.

Requirements

  • Experience in ABA, behavioural health, healthcare authorizations, medical billing, or insurance verification is preferred.
  • Strong understanding of prior authorizations, referrals, and insurance terminology is preferred.
  • Experience working with Medicaid and commercial insurance providers in the USA is preferred.
  • Experience using Availity and CentralReach is preferred.
  • Excellent attention to detail and strong organizational skills are required.
  • Ability to manage high volumes of work while meeting deadlines is required.
  • Strong written and verbal English communication skills are required.
  • Applicants must work Monday to Friday, 9:00 AM to 6:00 PM EST (3:00 PM to 12:00 AM South African time, subject to daylight savings).
  • Applicants must be available to work on both South African and U.S. public holidays.
  • A fixed fibre internet line with a minimum speed of 25 Mbps upload and download and wired Ethernet capability is mandatory.
  • A reliable power backup is mandatory to handle load shedding or outages.
  • Applicants without a fixed fibre line or power backup cannot be considered.

Benefits

  • Fully remote work environment.
  • Compensation for South African public holidays in accordance with the BCEA.
  • Opportunity to support U.S.-based healthcare companies as part of a dedicated client team.

Interested in this position?

Apply directly on the company website

Apply Now

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