ABA Authorization Manager

About us

Behavior Learning Tree is an ABA Clinic in Fayetteville, NC. We are professional, supportive, collaborative and our goal is to promote and provide kind, person-centered, and effective behavior analysis that will create lives that are more productive, happy, and freeing for the clients, families, team members, and the communities we serve.

Our work environment includes:

• Growth opportunities
• Regular social events
• Safe work environment
• Lively atmosphere

ABA Authorization Manager Job Duties

Client Intake & Onboarding

• Oversee and coordinate new client intake process
• Ensure all required documentation, consents, and intake materials are completed prior to service initiation
• Collaborate with intake, clinical, and scheduling teams to support timely service start

Authorization Management

• Submit initial and concurrent authorizations for all insurance payers (e.g., 97151, 97152, 97153, 97155, 97156)
• Ensure all submissions meet payer-specific requirements (Tricare, Medicaid, commercial plans, etc.)
• Monitor authorization status, approvals, expirations, and reauthorization timelines
• Track and manage authorization issues within client records (CR) to prevent service disruptions
• Verify insurance coverage monthly for each client

Utilization & Service Alignment

• Monitor utilization of authorized hours and identify risks (under/over-utilization)
• Collaborate with BCBAs and clinical leadership to align requested hours with client progress and medical necessity
• Support strategic planning around authorization timing and service delivery

Documentation Review & Treatment Plan Oversight

• Support reviewing treatment plans and supporting documentation for accuracy, completeness, and payer compliance prior to submitting authorization
• Conduct post-review of treatment plans as needed to ensure alignment with authorization requirements
• Ensure behavior reduction data and skill acquisition progress are included per payer expectations
• Provide feedback and request revisions when documentation does not meet standards

Compliance & Audit Readiness

• Maintain client file compliance with federal, state, and payer-specific requirements
• Audit client records to ensure completeness, accuracy, and readiness for review
• Prepare documentation for audits and respond to audit requests
• Maintain compliance records for private school and partnership agreements (excluding FS/Harnett County Schools)

Denials, Appeals & Issue Resolution

• Review authorization denials and determine root cause
• Draft and submit appeals with strong clinical justification
• Advocate for appropriate service hours and medical necessity
• Track trends in denials and implement process improvements

Team Collaboration & Communication

• Partner with BCBAs, Clinical Directors, Case Coordinators, and intake teams
• Communicate authorization requirements, deadlines, and updates clearly to staff
• Coordinate across departments to ensure continuity of care and timely submissions

Systems, Tracking & Process Management

• Maintain authorization trackers, client records, and internal systems (CR, spreadsheets, etc.)
• Ensure accurate data entry and reporting
• Develop and refine workflows to improve efficiency and reduce errors
• Create internal reference tools and guidance documents

Training, Credentialing & Professional Development

• Train staff on authorization processes, payer requirements, and documentation standards
• Research and share credentialing updates, CEU opportunities, and professional development resources
• Support ongoing staff development related to compliance and payer expectations

Reporting & Strategic Support

• Track and report key metrics (approval rates, denial rates, turnaround times, utilization)
• Identify risks related to revenue, compliance, and service delivery
• Support leadership with payer strategy, growth planning, and process scalability

Qualifications – ABA Authorization Manager

Required Experience & Education

• Minimum of 3 years of experience in ABA authorization management, medical billing, or insurance coordination
• Demonstrated experience working with ABA CPT codes (97151, 97152, 97153, 97155, 97156)
• Proven experience with major payers (Tricare, Medicaid, and commercial insurance plans)

Technical & Systems Knowledge

• Proficiency in CentralReach (CR) or similar ABA practice management systems
• Strong experience with authorization tracking systems, spreadsheets, and data management
• Ability to analyze utilization data, authorization trends, and reporting metrics

Clinical & Compliance Understanding

• Solid understanding of medical necessity, treatment plans, and ABA service delivery models
• Experience reviewing treatment plans and supporting documentation for payer compliance
• Knowledge of audit readiness standards and documentation requirements

Skills & Competencies

• Exceptional attention to detail with the ability to identify errors before submission
• Strong critical thinking and problem-solving skills, especially in denials and appeals
• Ability to manage multiple deadlines and prioritize in a fast-paced environment
• Clear and professional communication skills across clinical and administrative teams
• High level of accountability and ownership over assigned responsibilities

Leadership & Collaboration

• Experience training or guiding staff on authorization processes and payer expectations preferred
• Ability to collaborate effectively with BCBAs, Clinical Directors, and administrative teams
• Demonstrated ability to improve processes and implement efficient workflows

Preferred Qualifications

• Experience in a multi-site ABA organization
• Background in audit response and payer communication
• Bachelor’s degree required (Healthcare Administration, Psychology, Business, or related field preferred)

Job Type: Full-time

Pay: $45,000.00 - $60,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Professional development assistance
• Vision insurance

Experience:

• Insurance verification: 1 year (Preferred)

Work Location: In person

Salary : $45,000 - $60,000