Autism Advocate

Monroe, NY

Salary DOE

Review, understand, and analyze health insurance denials/rejections and determine appropriate next steps such as conducting appeals and appropriate next steps accordingly to prove medical necessity, and appropriateness of authorizations or claims payment for given cases. Ensuring that cases incorrectly denied by payors as not meeting medical necessity, or other standards are refuted with appropriate sources and law requirements to ensure ABA coverage for denied services.

Responsibilities:

• Understand denials, facilitating next steps (appeals/complaints), and following through to ensure member receives appropriate coverage for services requested
• Figure and gather applicable topics related to denials 
• Quote appropriate law and policy requirements in appeals and possible next steps 
• Write appeals for denied medical services
• Follow through on cases by obtaining case correspondence and proceeding accordingly

Qualificaitons:

• Familiarity with appeals and complaints processes
• Analytical thinking  
• Creative problem solving skills
• Excellent writing skills 
• Excellent organizational skills 
• Detail oriented 
• Great Reading comprehension 
• Adherence to deadlines 
• Quick and focused  
• Ability to work independently and as part of a team 
• Excellent computer skills, including Microsoft programs such as Excel, Word 
• Understanding of navigating the internet

Core Values: we hire/fire/promote based on these core values:



• Respectful of our unique cultural environment 
• Absolute Confidentiality 
• Embracing Teamwork 
• Loyal Behavior and Positive Attitude 
• Accountability 
• Proactiveness 
• Thoroughness 
• Focused on results 
• Inspired to learn & grow constantly