Description:
The Intake Specialist supports the full intake cycle for prospective ABA therapy clients, serving as a key point of contact for families, referring providers, and internal departments throughout enrollment. Working under the direction of the Lead Intake Specialist, this role is responsible for capturing and processing new referrals, verifying insurance eligibility, coordinating initial documentation, and supporting authorization workflows to move families from referral to active service as efficiently as possible. The ideal candidate is organized, compassionate, detail-oriented, and comfortable navigating healthcare insurance processes in a high-volume, regulated environment.
Key Responsibilities:
Referral Intake & Processing:
- Receive and log all incoming referrals via phone, fax, email, and referral portals in the intake tracking system accurately and in real time.
- Conduct initial eligibility screenings to verify insurance coverage, benefit levels, and ABA service authorization requirements.
- Gather and organize all required intake documentation from families and referring providers, including diagnostic evaluations, prescription letters, and consent forms.
- Communicate referral receipt and next-step instructions to families promptly and professionally.
- Escalate complex or high-priority referrals to the Lead Intake Specialist as appropriate.
Authorization Support:
- Assist in the preparation and submission of prior authorization requests for ABA services to Medicaid, managed care organizations, and commercial insurance payers.
- Follow up on pending authorization submissions and document status updates in the tracking system.
- Coordinate with clinical staff (BCBAs / LBAs) to collect required clinical documentation in support of authorization requests.
- Flag cases that may require Single Case Agreement (SCA) processing and refer them to the Lead Intake Specialist or SCA Specialist.
- Monitor approaching authorization expiration dates and initiate re-authorization outreach under the direction of the Lead Intake Specialist.
Family & Referral Source Communication:
- Contact families in a timely manner upon referral receipt to explain the intake process, collect required information, and address general inquiries.
- Provide empathetic and professional communication throughout the enrollment process, recognizing that families are often navigating a complex and unfamiliar system.
- Respond to inbound inquiries from families, pediatricians, schools, and other referral sources regarding intake status, required documents, and next steps.
- Ensure families are informed of any delays, documentation gaps, or payer-related requirements affecting their enrollment timeline.
Documentation & Data Integrity:
- Maintain accurate, complete, and up-to-date records for all referrals and active intake cases in the designated tracking system.
- Ensure all intake files meet documentation standards required by payers, regulatory bodies.
- Conduct routine audits of assigned intake cases to identify missing documents, outstanding items, or stalled pipeline stages.
- Generate status reports on assigned caseload as requested by the Lead Intake Specialist or Director of Operations.
Cross-Functional Coordination:
- Collaborate with the billing, clinical, and scheduling teams to ensure seamless handoff from intake authorization to active service delivery.
- Participate in intake team huddles, pipeline reviews, and cross-departmental coordination meetings as directed.
- Support the Lead Intake Specialist with special intake projects, payer-specific workflows, or capacity-driven assignments as needed.
- Adhere to all HIPAA regulations and confidentiality policies when handling client records and communications.
Requirements:
- High school diploma or equivalent required; Associate's or Bachelor's degree in Healthcare Administration, Human Services, Business, or a related field preferred.
- Minimum 1–2 years of experience in a healthcare intake, patient access, insurance coordination, or administrative support role.
- Working knowledge of health insurance terminology, including prior authorizations, eligibility verification, EOBs, and Medicaid managed care.
- Strong organizational skills with the ability to manage multiple active cases simultaneously without sacrificing accuracy.
- Excellent written and verbal communication skills, with demonstrated ability to communicate sensitively with families navigating healthcare systems.
- Proficiency in Microsoft Office Suite and/or Google Workspace; comfort learning new intake and tracking systems quickly.
- Strict adherence to HIPAA regulations and confidentiality standards in all aspects of the role.
Preferred:
- Experience in an ABA therapy, behavioral health, or pediatric healthcare intake or patient access environment.
- Familiarity with New York State Medicaid managed care plans, commercial payer prior authorization portals, and ABA-specific authorization requirements.
- Bilingual in English and Spanish — strongly preferred.
- Experience using electronic health record (EHR) systems, CRM platforms, or intake management software.
- Demonstrated ability to work within structured, process-driven environments with defined performance metrics and turnaround standards.
Minimum Technical and Work Environment Requirements:
Internet Connection:
- Primary internet connection with a minimum speed of 15 Mbps.
- Backup internet connection with at least 10 Mbps.
- Backup connection must be capable of supporting work during a power outage.
Primary Device:
- Desktop or laptop equipped with at least: Intel Core i5 (8th generation or newer), Intel Core i3 (10th generation or newer), AMD Ryzen 5, or an equivalent processor.
- A minimum of 8 GB RAM.
Backup Device:
- Must meet or exceed the performance of an Intel Core i3 processor.
- Must be functional during power interruptions.
Peripherals and Workspace:
- A functioning webcam.
- A noise-canceling USB headset.
- A quiet, dedicated home office space.
- A smartphone for communication and verification purposes.
