Billing & Authorization Manager

We are seeking a highly detail-oriented and organised Billing & Authorization Specialist to join our team. The successful candidate will be responsible for ensuring that billing codes, insurance authorizations, and supporting documentation are accurate, compliant, up to date, and correctly entered into the relevant EMR and billing systems.

The role requires strong knowledge of medical billing, insurance authorization processes, CPT codes, and payer requirements. Experience within pediatric healthcare, pediatric therapy, Early Intervention, behavioral health, or a similar healthcare environment would be highly advantageous.

The Billing & Authorization Specialist will work closely with therapists, clinicians, providers, and insurance companies to ensure that services are appropriately authorised and billed and that any discrepancies are resolved efficiently.

Key Responsibilities

• Review billing codes and insurance authorizations to ensure accuracy, completeness, and compliance.
• Ensure all required authorizations are obtained before services are billed.
• Monitor authorizations to ensure they remain current and proactively manage upcoming expirations or required extensions.
• Accurately enter and maintain authorization and billing information within the EMR and billing system.
• Verify that services are billed only when valid and appropriate insurance authorizations are in place.
• Follow up proactively with therapists, clinicians, and providers when required documentation, treatment information, or authorizations are missing.
• Communicate directly with insurance companies regarding authorization status, extensions, denials, payer requirements, and billing-related inquiries.
• Investigate and resolve billing discrepancies and authorization issues in a timely manner.
• Maintain accurate and well-organised records of authorizations, billing information, and related communications.
• Ensure all processes are completed in accordance with relevant payer requirements and company procedures.
• Work within an EMR and/or billing software platform commonly used by Early Intervention or pediatric healthcare providers.
• Identify potential authorization or billing issues before they impact service delivery or reimbursement.
• Collaborate with internal teams to ensure smooth communication and efficient resolution of outstanding matters.

Requirements

• Previous experience in medical billing and insurance authorizations.
• Strong understanding of CPT codes, medical billing processes, and payer requirements.
• Experience managing insurance authorizations, including obtaining, updating, extending, and resolving denied or missing authorizations.
• Excellent attention to detail and accuracy.
• Strong organisational and administrative skills.
• Ability to manage multiple authorizations, deadlines, and follow-ups simultaneously.
• Comfortable communicating professionally with therapists, clinicians, healthcare providers, and insurance companies.
• Strong problem-solving skills and the ability to investigate and resolve discrepancies independently.
• Experience working with EMR and/or medical billing software.