Verification of benefits and Authorization Specialist

Company Description Ārohana Support provides specialized billing, credentialing, and revenue cycle management services for pediatric therapy providers. The organization focuses on ABA, Speech, Occupational, and other pediatric therapies, delivering scalable solutions that help reduce operational costs and strengthen cash flow. Services include full-service billing, insurance credentialing, denial management, and claims follow-up designed to support clean claims and timely payments. A dedicated team of RCM professionals with deep pediatric care expertise works closely with therapy practices to streamline operations. The company is built for therapy practices, backed by data, and powered by people who understand the needs of pediatric providers.
Job Title: Verification of Benefits (VOB) & Prior Authorization Specialist
Department: Revenue Cycle Management (RCM) / Patient Financial Services / Medical Billing
Reports To: Billing Supervisor / Patient Access Manager / Revenue Cycle Manager
Employment Type: Full-time (On-site, Hybrid, or Remote)
Job Summary
The Verification of Benefits (VOB) and Prior Authorization Specialist plays a critical role in the front end of the healthcare revenue cycle. This position is responsible for verifying patient insurance eligibility and coverage details, identifying benefit limitations, and securing all necessary pre-authorizations or precertifications before medical services, procedures, or treatments are rendered. By ensuring accurate documentation and timely payer approvals, this specialist protects practice revenue, prevents claim denials, and facilitates smooth patient care.
Key Responsibilities1. Verification of Benefits (VOB) & Eligibility
Verify active coverage, policy effective dates, network status, copayments, coinsurance, deductibles, and out-of-pocket maximums via payer portals, clearinghouses, and direct payer phone inquiries.
Identify primary, secondary, and tertiary payer coordination of benefits (COB).
Confirm coverage limitations, carve-outs, pre-existing condition clauses, and service exclusions for upcoming admissions, appointments, or scheduled procedures.
Document comprehensive benefit details accurately in the Electronic Health Record (EHR) / Practice Management (PM) system within established turnaround times.
2. Prior Authorizations & Precertifications
Review provider clinical documentation, medical history, ICD-10 diagnosis codes, and CPT/HCPCS procedure codes to determine payer-specific authorization requirements.
Prepare, compile, and submit prior authorization requests via web portals, fax, or electronic submission systems with necessary supporting clinical notes and letters of medical necessity (LMN).
Track pending authorization requests, monitor status, and perform timely follow-ups to obtain approval numbers before scheduled service dates.
Record authorization numbers, approved date ranges, allowed units/visits, and specific authorized codes into patient accounts.
3. Denials, Appeals & Problem Resolution
Identify the cause of authorization delays, rejections, or denials (e.g., missing clinical data, non-covered services, lack of medical necessity).
Collaborate with clinical staff, physicians, and medical directors to obtain additional clinical justification or arrange peer-to-peer reviews.
Draft and submit reconsideration requests or formal appeals according to payer deadlines.
4. Patient & Interdepartmental Coordination
Communicate anticipated patient financial responsibilities (e.g., deductibles, estimated co-pays, non-covered charges) to front-desk and patient access teams.
Coordinate with scheduling and clinical teams regarding delayed or denied authorizations to avoid last-minute procedure cancellations or unbillable claims.
Assist billing and accounts receivable (A/R) teams in reviewing and resolving downstream claim denials related to missing or mismatched authorizations.
5. Compliance & Documentation
Adhere strictly to HIPAA, HITECH, and patient privacy standards across all verbal, written, and electronic communications.
Maintain current knowledge of payer guidelines (commercial payers, Medicare, Medicaid, and managed care plans).
Key Performance Indicators (KPIs)
Turnaround Time: Authorization and VOB requests completed within standard Service Level Agreements (e.g., within 24–48 hours of request).
Accuracy Rate: $\ge 98\%$ accuracy in benefit recording and data entry.
Denial Reduction: Zero or minimal claim rejections/denials attributed to missing, expired, or incorrect prior authorizations.
Follow-up Adherence: Routine daily tracking and resolution of all pending payer queues.
Qualifications & RequirementsEducation & Experience
Experience: Minimum of 2–3 years of experience in healthcare revenue cycle, insurance verification, medical billing, or prior authorization.
Skills & Competencies
Medical Coding & Terminology: Solid understanding of medical terminology, CPT, HCPCS, and ICD-10 coding.
Payer Knowledge: Familiarity with major commercial insurers (e.g., BCBS, Aetna, Cigna, UnitedHealthcare), Medicare, Medicaid, and worker's compensation authorization rules.
Technical Proficiency: Experience with EHR/PM systems (e.g., Epic, Cerner, AthenaHealth, NextGen, Kareo, Lightning Step) and clearinghouses (e.g., Availity, Change Healthcare).
Communication & Negotiation: Strong verbal and written communication skills for interacting with insurance reps, medical providers, and patients.
Attention to Detail: High precision in reviewing clinical documentation and managing reference numbers to avoid billing discrepancies.

Work arrangement
Yes