Senior Prior authorization Associate

The Senior Prior Authorization Associate is responsible for managing the end-to-end prior authorization process for ABA (Applied Behavior Analysis) services, ensuring authorizations are obtained accurately and on time to prevent any disruption to client care. This role requires strong payer knowledge, sharp attention to detail, and the ability to independently manage a high volume of complex cases, including denials, appeals, and peer-to-peer coordination.

The Senior Prior Authorization Associate will also ensure timely authorization approvals, conduct 100% quality audits, and provide & handle escalated Authorization Cases.

Key ResponsibilitiesIntake Operations

• Manage and monitor incoming tickets, referrals, and fax queues
• Ensure all intake requests are triaged, responded to, and completed on time
• Maintain SLA adherence and optimize turnaround times
• Ensure accurate patient intake, insurance verification, and data entry

• Prioritize urgent cases to prevent delays in care

   

Prior Authorization Oversight

• Oversee end-to-end prior authorization processes
• Ensure authorizations are obtained timely and prior to patient visits
• Track pending requests and follow up with payers

• Handle escalated delays and complex cases as needed

   

Quality Assurance

• Conduct 100% audit of auth output (intake and auth)
• Ensure compliance with payer guidelines and internal standards
• Identify errors, trends, and implement corrective actions

• Serve as escalation point for issues and bottlenecks

   

Training & Development

• Train, onboard, and coach auth co-workers
• Develop SOPs and workflow documentation

• Provide continuous feedback to improve quality and efficiency

   

Collaboration

• Work closely with scheduling, billing, and clinical teams
• Communicate intake and authorization updates proactively
• Partner with leadership to improve RCM performance

Qualifications Required

• 3+ years of experience in Revenue Cycle Management (RCM)
• Experience working in an Outpatient ABA Therapy Clinic
• Experience working in TX behavioral health market
• Experience working in authorization-related denials
• Strong knowledge of intake, insurance verification, and prior authorizations
• Experience managing work queues (tickets, faxes, referrals)

• Prior supervisory experience

   

Preferred

• Experience with EMR/EHR systems
• Familiarity with U.S. insurance payers and authorization rules
• Process improvement experience is a plus

Skills

• Strong attention to detail and accuracy
• Excellent communication and leadership skills
• Ability to manage multiple priorities in a fast-paced environment

• Problem-solving and analytical mindset

   

Key Metrics for Success

• Intake turnaround time (TAT)
• Authorization turnaround and approval rates
• Queue resolution times
• Audit accuracy (target: 100%)
• Reduction in authorization-related denials

Experience:

• RCM: 3 years (Required)

Work Location: Remote