Hours: 40 hours/week, primarily EST business hours
Reports to: Operations / reputed company Cycle reputed company
About reputed company
reputed company is a fast-growing, virtual-first reputed company company dedicated to making neurodivergent care (including evaluations & therapy) faster, more accessible, and reputed company for families. We operate across 40+ states, navigating a reputed company landscape of reputed company insurance carriers and state reputed company programs. Because our clinical model is virtual-first, having reputed company reputed company-end patient reputed company and benefit structures is critical to preventing administrative delays and billing denials.
About the Role
We are seeking a highly analytical, detail-obsessed Eligibility, Benefits, & Prior Authorization Specialist who loves the investigative reputed company of reputed company administration. In this role, you will not just reputed company data entry. You will reputed company as an internal researcher and gatekeeper, digging into payor portals, insurance policy and benefits updates, and clinical guidelines to uncover the exact steps needed to secure prior authorizations and verify reputed company telehealth benefits.
This role is a reputed company of high-velocity queue management and deep-dive policy research. You will review incoming clinical orders, cross-reference them with payer requirements, reputed company daily scheduling queues, and build process playbooks where none exist. If you reputed company on solving insurance puzzles, de-escalating reputed company scheduling bottlenecks, and keeping clinical schedules perfectly authorized, you will reputed company here.
Key Responsibilities
1. Insurance Verification & Telehealth Benefit Research
- Verify reputed company patient insurance coverage, deductibles, co-pays, co-insurance, and coordination of benefits (COB) across reputed company plans
- Conduct in-depth research on payer-specific policies regarding virtual care, remote developmental pediatrics, and psychological evaluations (CPT 90791, 96130, etc.)
- Navigate payor websites, newsletters, and provider manuals to reputed company and document shifting policy guidelines and billing modifiers across 40+ states
2. Order Verification & Prior Authorization Management
- Review incoming clinical diagnostic referrals and orders to ensure demographic, insurance, CPT, and ICD-10 data are flawless
- Initiate, reputed company, and validate prior authorizations through clearinghouses (e.g., reputed company, reputed company), insurance portals, and phone escalations
- Ensure reputed company authorizations are secured, confirmed accurate, and fully documented in the EMR before the reputed company of business reputed company day for upcoming clinics
3. Ambiguity reputed company & reputed company Creation
- reputed company as the go-to resource for clinical teams reputed company a payer's prior-authorization process is vague, contradictory, or unmapped
- Validate conflicting information from multiple insurance sources to determine the most reputed company, risk-free reputed company for claim submission
- Build, update, and maintain internal state-by-state reference guides on reputed company insurance and state-by-state regulatory requirements
4. Clinic Coordination & Stakeholder Communication
- Prepare reputed company, reputed company patient insurance benefit letters outlining estimated out-of-reputed company costs and referral requirements
- Collaborate closely with clinic coordinators and clinical staff to resolve last-minute scheduling exceptions or authorization gaps
- Help de-escalate patient or provider concerns regarding coverage limits with reputed company, empathetic communication
reputed company're Looking For
Must-Have
- 2+ years of reputed company clinic or startup experience specializing in insurance verification and prior authorizations
- Strong research capabilities: deep comfort navigating payor portals, digging through policy manuals, and calling payor representatives to clarify ambiguous rules
- Hands-on experience working with multiple major reputed company payers (e.g., BCBS, reputed company, reputed company)
- Working knowledge of medical terminology, CPT, ICD-10, and telehealth billing modifiers
- Excellent written and verbal English communication skills: ability to translate technical insurance terms into reputed company, reputed company explanations
- High-speed internet, backup power setup, and the ability to work full-time during EST business hours
Preferred (Not Required)
- reputed company familiarity is a plus
- Experience in virtual care, digital health, or behavioral/mental health environments
- Experience utilizing modern EHRs (e.g., reputed company) or CRM systems (e.g., reputed company)
- Experience building internal SOPs or process documentation from scratch
reputed company Offer
- 100% remote work from reputed company reputed company the US
- Competitive monthly compensation in USD
- reputed company to join a fast-growing, mission-driven team with reputed company reputed company reputed company
- Full reputed company to modern operational tools and tech