Job Description

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 clients
• Provides effective communication to clients in a friendly, professional manner
• Answers all client calls and provides follow up as needed

Insurance & Authorizations

• Tracks and compiles clinical information for insurance authorizations and reauthorizations as needed
• Tracks client authorization status on health management system
• Works with Intake team on annual insurance change procedures
• Completes verification of benefits as required
• Facilitates insurance authorization live reviews with clinical team
• Communicates with payor representatives to foster partnership and collaboration
• Ensures clients maximize authorized hours and prevent underutilization, while adhering to authorization limits and avoiding overutilization
• Maintains provider and supplier authorization changes, ensuring accurate updates and compliance with requirements
• Manages medical records requests, ensuring timely processing and adherence to privacy and regulatory standards
• Address and resolve any authorization-related issues or concerns from patients, healthcare providers, or insurance companies
• Process 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 team
• Utilize Key Performance Indicators (KPIs) to track authorization metrics and improve efficiency in the authorization process
• Review authorization processes and documentation for accuracy, compliance, and completeness, working to resolve any discrepancies or issues
• Stay informed of payer-specific requirements for authorization, documentation, and medical necessity, ensuring all necessary documentation is submitted for approval
• Advocate on behalf of clients to ensure they receive the medically necessary hours of service as determined by their treatment plans and payer guidelines
• Communicate with families about the importance of adhering to the recommended service intensity to ensure the best outcomes for their child’s therapy

Credentialing

• Manages the credentialing process, ensuring all providers meet regulatory requirements and maintaining up-to-date documentation for compliance
• Ensure timely submission of applications and supporting documents to insurance companies and other credentialing entities
• Maintain accurate and up-to-date records of all credentialing and re-credentialing activities

Team Collaboration

• Coordinates with Intake and Clinical Team to ensure accuracy of clinical information prior to submitting to insurance company
• Collaborates with the billing department to resolve billing discrepancies and aging issues, including identifying outstanding claims, following up on denials, and ensuring timely payment resolution

Community Engagement

• Serves as company ambassador representing the company mission, vision and culture
• Communicates with related service professionals to request diagnostic information
• Represents the organization through participation in community events

Other

• General office tasks i.e., filing, scanning, organizing
• Performs other duties as required

ORGANIZATIONAL 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 experience
• Experience in medical/behavioral/mental health/therapy related organization
• 2+ years of experience with direct customer engagement, focused on growth and retention
• Experience in an environment with a strong customer service focus
• Commercial and Medicaid authorization experience

ADDITIONAL ELIGIBILITY REQUIREMENTS

• Professional, energetic, and positive attitude
• Excellent customer service skills
• Excellent verbal and written communication skills necessary to explain complex and/or confidential information
• Able to maintain high level of confidentiality
• Strong administrative, organizational and problem-solving skills
• Developing standards, promoting process improvement, reporting skills
• Analytical skills
• Self-starter
• Proficient in Microsoft Office

CLASSIFICATION

Non-Exempt

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