Supports company operations by following company policies and procedures. Responsible for performing a variety of duties. This position requires an individual to be multi-tasked, have computer and general office technology skills, great communication skills, and be efficient. The Authorization Coordinator will help bring in additional business for the company by identifying, developing, and maintaining referral sources and potential clients. Ensures smooth operation of the organization, its core values and mission by being a friendly, welcoming ambassador to the organization’s clients, staff, and visitors.
COMPETENCIES
- Excellent Verbal and Written Communication Skills
- Strong Interpersonal Skills
- Detail-Oriented
- Customer Service Focused
- Growth Minded
- Ethical Practice
- Resourceful and Results-Driven
- Critical Evaluation
- Team-Oriented
- Self-Starter
- Adaptable
- Problem-Solver
MAJOR DUTIES AND RESPONSIBILITIES
Client Engagement
Builds and maintains strong, effective relationships with clientsProvides effective communication to clients in a friendly, professional mannerAnswers all client calls and provides follow up as neededInsurance & Authorizations
Tracks and compiles clinical information for insurance authorizations and reauthorizations as neededTracks client authorization status on health management systemWorks with Intake team on annual insurance change proceduresCompletes verification of benefits as requiredFacilitates insurance authorization live reviews with clinical teamCommunicates with payor representatives to foster partnership and collaborationEnsures clients maximize authorized hours and prevent underutilization, while adhering to authorization limits and avoiding overutilizationMaintains provider and supplier authorization changes, ensuring accurate updates and compliance with requirementsManages medical records requests, ensuring timely processing and adherence to privacy and regulatory standardsAddress and resolve any authorization-related issues or concerns from patients, healthcare providers, or insurance companiesProcess Improvement : Identify and recommend improvements to the authorization process to increase efficiency and reduce delays.Assist in the development and implementation of best practices for authorization management in collaboration with the billing teamUtilize Key Performance Indicators (KPIs) to track authorization metrics and improve efficiency in the authorization processReview authorization processes and documentation for accuracy, compliance, and completeness, working to resolve any discrepancies or issuesStay informed of payer-specific requirements for authorization, documentation, and medical necessity, ensuring all necessary documentation is submitted for approvalAdvocate on behalf of clients to ensure they receive the medically necessary hours of service as determined by their treatment plans and payer guidelinesCommunicate with families about the importance of adhering to the recommended service intensity to ensure the best outcomes for their child’s therapyCredentialing
Manages the credentialing process, ensuring all providers meet regulatory requirements and maintaining up-to-date documentation for complianceEnsure timely submission of applications and supporting documents to insurance companies and other credentialing entitiesMaintain accurate and up-to-date records of all credentialing and re-credentialing activitiesTeam Collaboration
Coordinates with Intake and Clinical Team to ensure accuracy of clinical information prior to submitting to insurance companyCollaborates with the billing department to resolve billing discrepancies and aging issues, including identifying outstanding claims, following up on denials, and ensuring timely payment resolutionCommunity Engagement
Serves as company ambassador representing the company mission, vision and cultureCommunicates with related service professionals to request diagnostic informationRepresents the organization through participation in community eventsOther
General office tasks i.e., filing, scanning, organizingPerforms other duties as requiredORGANIZATIONAL RELATIONSHIPS
Reports directly to the Director of Admissions
SUPERVISORY RESPONSIBILITIES
N / A
WORK ENVIRONMENT
This job operates in a professional office environment. This role routinely uses standard office equipment.
PHYSICAL DEMANDS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job with or without reasonable accommodations. While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to type, handle objects, tools or controls; reach with hands and arms; climb stairs; talk or hear.
POSITION TYPE / EXPECTED HOURS OF WORK
This is a full-time position. Days and hours of work are Monday through Friday, 8 : 30 a.m. to 5 : 30 p.m.
TRAVEL
Travel (if any) is minimal and primarily local during the business day.
PREFERRED EDUCATION AND EXPERIENCE
2-to-4-year degree in business / healthcare administration and / or equivalent experienceExperience in medical / behavioral / mental health / therapy related organization2 years of experience with direct customer engagement, focused on growth and retentionExperience in an environment with a strong customer service focusCommercial and Medicaid authorization experienceADDITIONAL ELIGIBILITY REQUIREMENTS
Professional, energetic, and positive attitudeExcellent customer service skillsExcellent verbal and written communication skills necessary to explain complex and / or confidential informationAble to maintain high level of confidentialityStrong administrative, organizational and problem-solving skillsDeveloping standards, promoting process improvement, reporting skillsAnalytical skillsSelf-starterProficient in Microsoft OfficeCLASSIFICATION
Non-Exempt
