Care Readiness Denials & Audit Specialist

Care Readiness Denials & Audit Specialist

Make an Impact Behind the Scenes That Improves Patient Access to Care

Behavioral Innovations is seeking a highly analytical, detail-oriented Care Readiness Denials & Audit Specialist to join our growing Care Readiness team. In this role, you will play a vital part in protecting revenue, reducing authorization denials, and ensuring children receive uninterrupted ABA therapy services.

If you have experience managing insurance authorizations, insurance verifications, denial management, revenue recovery, CPT coding validation, coordination of benefits (COB, and navigating complex payer requirements, this is an opportunity to make a measurable impact while partnering with clinical, billing, credentialing, and operations teams across a rapidly growing healthcare organization. This position is ideal for someone who enjoys investigating complex issues, solving problems, identifying process improvements, and driving successful reimbursement outcomes.

Location: Corporate Office - Plano, TX

Schedule: Full-Time | Monday-Friday | Hybrid schedule after the 60–90 day training period based on individual performance.

What You'll Do:

As the Care Readiness Denials & Audit Specialist, you'll serve as the subject matter expert for authorization denials, eligibility issues, coordination of benefits (COB), and authorization-related coding accuracy.

Key Responsibilities

• Investigate, analyze, and resolve authorization, eligibility, and coordination of benefits (COB) denials within payer-required timelines.
• Research insurance denial root causes and develop resolution plans that maximize reimbursement opportunities.
• Manage ABA therapy prior authorization requirements for commercial, Medicaid, and managed care payers, including initial authorizations, concurrent reviews, and reauthorizations.
• Verify that all dates of service are properly authorized and linked to the appropriate CPT codes before claims are submitted.
• Identify authorization gaps and pursue retro-authorizations, appeals, corrections, and other recovery opportunities.
• Audit authorizations and CPT coding to ensure services billed accurately align with payer approvals.
• Verify provider credentialing and qualification requirements for payer-specific billing guidelines.
• Partner closely with Billing, Credentialing, Clinical Operations, Area Leadership, Regional Leadership, and insurance payers to resolve complex authorization issues.
• Analyze denial trends, identify systemic issues, and recommend process improvements to reduce future denials.
• Maintain detailed documentation within CentralReach, Salesforce, payer portals, and internal systems.
• Prepare reports on denial trends, audit findings, recoveries, and process improvement opportunities.
• Participate in departmental meetings, audits, training, and special projects.

What Success Looks Like:

In this role, you will help the Care Readiness team achieve measurable operational outcomes by:

• Reducing authorization-related denials by 10% through proactive denial management and root cause analysis.
• Increasing revenue recovery opportunities by 20% through successful appeals, retro-authorizations, coding corrections, and reimbursement recovery.
• Improving authorization accuracy and ensuring uninterrupted access to care for our patients.

What We're Looking For:

Qualifications

• 2–3+ years of experience in one or more of the following:
  • Medical Billing
  • Revenue Cycle
  • Authorization Management
  • Denials Management
  • Healthcare Reimbursement
• Experience working with commercial, Medicaid, and managed care insurance payers.
• Knowledge of insurance authorization processes and denial resolution.
• Understanding of Coordination of Benefits (COB) rules and payer sequencing.
• Experience navigating payer portals and clearinghouse systems, and EMR/EHR platforms.
• Strong analytical, organizational, and problem-solving abilities.
• Excellent written and verbal communication skills.
• Ability to manage multiple priorities while maintaining exceptional accuracy and attention to detail.
• Demonstrated ability to work independently while collaborating across multiple departments.

Preferred Qualifications

• Bachelor's degree.
• Experience using CentralReach (CR)
• Experience using Salesforce.
• Experience supporting Applied Behavior Analysis (ABA) or behavioral health organizations.
• Knowledge of ABA authorization requirements and medical necessity guidelines.
• Working knowledge of ABA CPT coding and authorization validation.
• Experience conducting authorization or coding audits.

Why Join Behavioral Innovations?

At Behavioral Innovations, our mission is to improve the lives of children with autism and the families we serve. Behind every successful therapy session is a team committed to removing barriers to care - and that's where you come in.

You'll join a collaborative organization that values continuous improvement, teamwork, accountability, and innovation while offering opportunities for professional growth in a rapidly expanding healthcare organization.

You'll Thrive Here If You...

• Enjoy solving complex insurance and reimbursement challenges.
• Take pride in accuracy and attention to detail.
• Like identifying trends and improving processes.
• Communicate confidently with insurance companies and cross-functional teams.
• Are motivated by measurable outcomes and continuous improvement.
• Enjoy working in a fast-paced, mission-driven healthcare environment.

Join Behavioral Innovations and help ensure every child receives the care they need by removing barriers before they become obstacles. Apply today!

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