What are the responsibilities and job description for the ABA Authorization Expert position at Calpion/Plutus Health?
About Plutus Health Inc.:
Plutus Health Inc. is a leading provider of Revenue Cycle Management (RCM) services with SOC2 Certification. We are dedicated to helping healthcare providers improve their financial performance. Our expertise spans across various specialties. We are committed to delivering exceptional service and innovative solutions to our clients. As a result, Plutus Health Inc. has been recognized on the 5000 list of the fastest-growing private companies in America and ranked 100 in the Dallas area. Additionally, the company has been a 2024 finalist in the EY Entrepreneur Of The Year.
Job Summary
Plutus Health Inc. is seeking a highly skilled ABA Authorization Expert to oversee and optimize the authorization and re-authorization process for Applied Behavior Analysis (ABA) services. This role requires extensive experience managing large volumes of authorizations while maintaining a strong client interface to ensure seamless communication, exceptional service delivery, and adherence to payer requirements. As a key member of our team, you will play a critical role in driving efficiency, resolving challenges, and enhancing operational outcomes.
Key Responsibilities
- Authorization Management: Oversee the complete authorization and re-authorization process for ABA therapy services, ensuring compliance with payer guidelines and regulations while managing high volumes efficiently.
- Client Interfacing: Serve as the primary point of contact for clients regarding authorization-related activities, building strong relationships and maintaining open communication.
- Denial Resolution: Proactively address and resolve authorization denials, delays, or discrepancies to minimize service interruptions.
- Documentation Oversight: Ensure clinical documentation aligns with payer standards and work closely with clinicians to acquire any additional required information.
- Process Improvement: Continuously evaluate, refine, and implement best practices in authorization workflows to enhance efficiency and reduce turnaround times.
- Stakeholder Collaboration: Act as a liaison between insurance companies, clinical teams, and clients to ensure smooth operations and issue resolution.
- Performance Monitoring: Track and report key performance indicators (KPIs), including authorization success rates and turnaround times, while providing actionable insights to leadership.
Qualifications
- Bachelor’s degree in healthcare administration, business, or a related field (preferred).
- 5 years of experience managing large volumes of ABA authorizations and re-authorizations.
- Strong knowledge of ABA therapy practices, payer guidelines, and insurance protocols.
- Proven experience in client interfacing and stakeholder management.
- Proficiency in RCM software and healthcare management systems.
- Exceptional analytical, organizational, and problem-solving skills.
- Excellent communication and interpersonal abilities.
Why Join Plutus Health Inc.?
- Work for a fast-growing, innovative company recognized for excellence in the healthcare industry.
- Collaborate with a team that values growth, diversity, and professional development.
- Make a significant impact on patient care, client satisfaction, and operational success.
