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.