Medical Necessity Specialist

Summary: 

We are looking for an assertive and driven clinical professional to join our team in a crucial administrative role to help our ABA Therapy organization grow! Action Behavior Centers is a leading development organization for children with autism based out of Austin, Texas. With numerous clinics opening up across the United States, we need someone who shares our vision for expansion and wants to help take us there. Our Corporate Team needs someone passionate about helping kiddos with autism get the therapy they need. This role will support the Vice President of Clinical Services, the Director of Clinical Advocacy and Authorizations, and the Regional Autism Advocate(s) with time-sensitive documentation fidelity and discuss clinical needs with insurance companies. The ideal candidate will be a RBT having worked in the field with various demographics of children impacted with Autism and has a hunger for continued growth in knowledge of ABA & Autism services, OR a Registered Behavior Technician (RBT) completing their Master’s Program to become a Board Certified Behavior Analyst (BCBA) with only indirect hours left to be able to sit for the Behavior Analyst Certification Board (BACB) Exam to become a BCBA would be ideal.

Requirements:

• Familiarity with SalesForce is recommended but not required
• Registered Behavior Technician (RBT) required; An RBT with 2+ years of clinical experience is preferred
• Working knowledge and understanding of Applied Behavior Analysis (ABA) therapy is strongly recommended 
• Previous experience negotiating with insurance companies
• A strong, pleasant personality with a high EQ 
• Extremely detail oriented – you minimize mistakes because you care about how your work affects patients
• Assertive and strong communication style - you know how to get what you want because you can eloquently present the facts and advocate for patient services
• You possess a high-level of organizational skills - you rarely drop the ball because you love having systems in place to keep things running smoothly
• You like to work really hard – you aren’t watching the clock for quittin’ time because there is always more than needs to be done, and you like that
• Undergraduate is ideal but not required

Responsibilities:

• Assisting Regional Autism Advocate(s) in campaigning to insurance companies on patient services
• Review and confirm patient intake paperwork
• Review & proof read patient reports provided by BCBAs and prepare patient documents for insurance authorization requirements
• Manage & upkeep patient paperwork in SalesForce 
• Participate in meetings with the Corporate Team
• Maintain patient communication with the Office Managers across all ABC locations
• Assist Regional Autism Advocate(s) and Director of Clinical Advocacy and Authorizations with Ad Hoc projects. This may also be inclusive of Ad Hoc projects from our Vice President of Clinical Services.
• Oversees and maintains the company's healthcare data entry procedures within HIPAA compliance guidelines.
• Confirm authorization via phone calls, and enter authorization documents quickly and accurately.
• Confirm, maintain and enter patient's healthcare and authorization information with sensitivity and discretion into the EMR/billing system.
• Fax and submit for authorization of treatment.
• Schedule Peer-to-Peer (P2P) calls for insurance companies; This includes scheduling P2P calls for our BCBAs regarding general or specific clinical case discussions, etc.
• Account for submission and resubmission to new insurance companies with updated paperwork

**This position is remote (quarterly/semi-annual travel to Austin). If in Austin, 2x per week attendance in HQ is required.**