Authorization Specialist

Who We Are
Proficio Therapy Services is a mission driven therapy organization dedicated to improving the lives of children and families. We provide high quality ABA Therapy, Speech Therapy, and Occupational Therapy through our family of licensed clinical entities:

• AGES Learning Solutions LLC ABA Therapy
• Proficio Speech Therapy Group Inc Speech Therapy
• Childs Play Therapy Services PC Occupational Therapy

Today, we operate 11 clinics across the United States, supported by more than 250 clinicians. We are actively expanding into additional cities throughout California and Utah, with international growth underway in India and the Middle East.

Our teams are backed by strong clinical leadership, reliable operational systems, and a culture built on respect, inclusion, and collaboration. Whether youre starting your career or stepping into leadership, youll find opportunities to grow, contribute, and make a meaningful impact every day.

At Proficio, your work truly matters and so does your growth. Join us as we continue building a unified, global therapy organization dedicated to empowering children and families.

Role Overview

We are seeking a detail-oriented and proactive Authorization Specialist to join our growing healthcare operations team. In this role, you will be responsible for securing, monitoring, and managing insurance authorizations for Applied Behavior Analysis (ABA) services, ensuring uninterrupted care for clients while maintaining compliance with payer requirements.

You will collaborate closely with Intake, Clinical, Scheduling, and Billing teams to ensure authorizations are obtained on time, accurately documented, and proactively managed to prevent service disruptions and revenue loss.

Key Responsibilities

Insurance Authorization Management

• Obtain initial, concurrent, and re-authorizations for ABA services.
• Verify insurance eligibility, benefits, coverage limitations, CPT codes, and authorization requirements.
• Submit authorization requests through payer portals, fax, or other approved channels.
• Monitor authorization status, including approvals, denials, partial approvals, and pending requests.
• Track authorization expiration dates and initiate renewals well in advance.
• Follow up regularly with insurance companies to ensure timely approvals and minimize service interruptions..

Documentation & Compliance

• Collect, review, and maintain all required supporting documentation, including:

• Diagnostic evaluations

• Treatment plans

• Clinical assessment reports

• Physician prescriptions or referrals (where applicable)

• Ensure documentation complies with payer-specific guidelines and regulatory requirements.

• Maintain accurate and up-to-date authorization records within the EMR and internal tracking systems.

• Ensure complete documentation for audit readiness and payer compliance.

Cross-Functional Coordination

• Work collaboratively with:

• Client Operations team

• BCBAs and Clinical teams

• Scheduling team

• Billing and Revenue Cycle Management teams

• Communicate authorization status and updates to all relevant stakeholders.

• Escalate authorization delays or issues that could impact client services or billing timelines.

• Support smooth client onboarding by ensuring required authorizations are secured before services begin.

Reporting & Process Adherence

• Maintain authorization trackers, dashboards, and performance reports.
• Monitor authorization turnaround times and aging reports.
• Ensure adherence to established Service Level Agreements (SLAs) and departmental Key Performance Indicators (KPIs).
• Assist with payer audits, compliance reviews, and process improvement initiatives.
• Identify workflow improvement opportunities to enhance authorization efficiency and accuracy.

Qualifications

• Bachelor's degree in Healthcare Administration, Life Sciences, Business Administration, or a related field.
• Minimum 3 years of experience in a Medical Authorization, Prior Authorization, or Healthcare Insurance Authorization role.
• Experience supporting U.S. healthcare operations is required**.**

Required Knowledge & Skills

• Strong understanding of U.S. medical insurance authorization processes.
• Knowledge of ABA services and clinical workflows.
• Familiarity with ABA CPT codes
• Experience working with commercial insurance payers and Medicaid plans.
• Excellent analytical, organizational, and problem-solving skills.
• Strong verbal and written English communication skills.
• Ability to prioritize multiple authorizations while meeting strict deadlines.
• High attention to detail and commitment to accuracy.

Preferred Qualifications

• Experience supporting multi-state ABA operations.
• Hands-on experience with CentralReach or similar EMR/Practice Management systems.
• Knowledge of payer portals and electronic authorization platforms.
• Experience handling authorization appeals and medical necessity reviews.
• Background in Healthcare Revenue Cycle Management (RCM), Client Operations, or Medical Billing.
• Advanced proficiency in Microsoft Excel and Google Workspace.

Tools & Systems

• Central Reach (preferred)
• EMR / Practice Management Systems
• Insurance Payer Portals
• Clearinghouses
• Google Workspace
• Microsoft Excel

Salary & Benefits

• Monthly Salary: 35,000 40,000
• Medical insurance coverage.
• Annual performance-based incentives.
• Paid time off.
• Work From Office (WFO).