Authorization & Eligibility Specialist

Job Title: Authorization and Eligibility Specialist
Company: ANNA (Allied Network for Neurodevelopmental Advancement)
Location: Remote – Philippines
Job Type: Full-Time

Schedule: EST business hours, Monday–Friday

Salary: $16k-$22K per year USD

Position Overview

The Authorization & Eligibility Specialist is responsible for obtaining prior authorizations and verifying insurance coverage to support families in understanding and accessing their current benefits. This position plays a critical role in ensuring timely access to care by minimizing delays in service initiation and helps streamline the intake process, prevent disruptions in care, and support efficient reimbursement across the revenue cycle. Reporting to the Director of Revenue Cycle Management, this individual will work closely with clinical and billing teams to coordinate authorization and eligibility workflows, ensure accurate and timely information exchange, and support a seamless client onboarding experience.

Key Responsibilities

• Benefits & Eligibility

• Verify client insurance eligibility and active coverage prior to start of services

• Review and document benefit details including copays, deductibles, coinsurance, visit limits, and exclusions

• Confirm in-network/out-of-network status

• Identify services requiring prior authorization based on payer guidelines and benefit plans

• Communicate benefit coverage and potential financial responsibility with families

• Maintain accurate and up-to-date documentation of eligibility verification in the practice management system

• Monitor eligibility monthly and flag coverage lapses, plan changes, and retro activation that may delay care or impact reimbursement

• Authorizations:

• Submit initial and ongoing prior authorization requests to insurance payers

• Ensure all required clinical documentation is complete and aligned with payer requirements

• Track authorization status and follow up with payers to prevent delays in service start or continuation

• Manage authorization approvals, denials, and modifications (including units, dates, and service codes)

• Coordinate with clinical teams to align authorized services with treatment plans

• Maintain detailed records of authorization activity, including reference numbers and approval details

Qualifications:

• Required:

• Minimum of 1-2 years in insurance verification and prior authorizations.

• Working knowledge of health insurance payers. (Commercial, Medicaid, Managed Care)

• Experience verifying benefits and submitting authorizations through payer portals

• Strong attention to detail with a high level of accuracy in documentation

• Effective communication skills, with the ability to collaborate across clinical and operations teams

• Preferred:

• Experience with behavioral health and/or, Applied Behavior Analysis (ABA) Therapy.

• Familiarity with managed care organizations (MCOs) and state-specific Medicaid plans (e.g., MassHealth or similar)

• Prior experience working in a multi-site or high-growth healthcare organization

• Knowledge of medical necessity criteria and payer-specific authorization guidelines

ANNA is an equal opportunity employer. We’re committed to creating a diverse, inclusive, and supportive workplace. If you’re passionate about our mission but don’t meet every qualification listed, we still encourage you to apply. Your unique perspective might be exactly what we need.