Authorization Specialist (ABA Services | USA Healthcare) - EST Hours

ISTA Personnel Solutions South Africa is a dynamic, fast-growing BPO company providing operational support to U.S.-based healthcare companies. We are not a recruitment agency — we act as a dedicated extension of our clients’ teams, delivering high-quality service with precision and professionalism.

We are seeking a detail-oriented Authorization Specialist with experience in healthcare insurance authorizations, ideally within ABA, autism services, behavioural health, or medical billing. This role will support benefit verification, prior authorization submissions, reauthorizations, payer follow-ups, and accurate documentation to ensure ABA therapy services remain approved and uninterrupted.

PLEASE NOTE:

• Working Hours: Monday – Friday | 9:00 AM – 6:00 PM EST (3:00 PM – 12:00 AM South African time – subject to daylight savings).
• Public Holidays: This role requires working on both South African and U.S. public holidays (compensation for SA public holidays in accordance with the BCEA).
• Internet Requirements: A fixed fibre line with a minimum speed of 25 Mbps (upload & download) and wired Ethernet capability is mandatory. Applicants without a fixed fibre line cannot be considered.
• Power Backup: Reliable backup required to manage load shedding or outages. Applicants without a power backup cannot be considered.
• Work Environment: Fully remote.

Key Responsibilities:

• Verify patient insurance eligibility and ABA benefits using Availity and CentralReach, including both commercial and Medicaid payers.
• Submit initial authorization and reauthorization requests for ABA therapy services.
• Monitor authorization statuses, approved hours, visit limits, and expiration dates.
• Follow up with insurance providers regarding pending, denied, or incomplete authorizations.
• Work closely with Intake, Scheduling, Clinical, and Billing teams to ensure continuity of care.
• Obtain and upload required clinical documentation for authorization submissions.
• Maintain accurate records and updates within CRM/EHR systems.
• Assist with appeals, denied claims, and authorization discrepancy resolutions.
• Communicate professionally with families regarding insurance requirements and authorization updates.
• Ensure all authorizations are obtained and renewed before services lapse.
• Track payer-specific requirements, documentation guidelines, and turnaround times.
• Generate reports and maintain spreadsheets relating to authorization approvals and renewals.
• Escalate urgent authorization issues that may impact patient scheduling or treatment delivery.
• Support process improvement initiatives to streamline authorization workflows.

Preferred Experience:

• Previous experience in ABA, behavioural health, healthcare authorizations, medical billing, or insurance verification.
• Strong understanding of prior authorizations, referrals, and insurance terminology.
• Experience working with Medicaid and commercial insurance providers in the USA.
• Experience using Availity and CentralReach systems.
• Excellent attention to detail and organizational skills.
• Ability to manage high volumes of work while meeting deadlines.
• Strong written and verbal English communication skills.

If you are not contacted within 14 working days, please consider your application unsuccessful.