Job Description
The Authorization Coordinator position ensures the timely, thorough, and accurate coordination of client Third Party Payer verifications and authorizations so that appropriate services can commence and continue with our clients.
Essential Functions : Authorizations
- Manages the authorization process to include timely receipt of authorizations from Third Party Payers.
- Ensures authorization status is appropriately communicated.
- Coordinates intake Third Party Payer information and enters into the system.
- Maintains practice management system(s) with authorized hours information.
Billing - Gathers complete billing information for each client for all pay sources by working closely with Intake Coordinator.
- Creates a system for billing requirements for each client and maintains this record system as it changes. Communicates relevant billing information to Billing Specialist.
- Verifies benefits with insurance companies.
- Updates documentation on authorization policies and procedures and communicates to Billing Manager.
- Understands principles of ICD-10 and CPT coding for initial evaluations, treatment plans and ABA Therapy for authorizations to maximize revenue.
- Answers and fields billing and insurance questions with families.
- Maintains billing information in the practice management systems.
- Acts as a resource for Billing Specialists for authorizations and insurance verification issues.
- Reviews denials and implements timely appeal solutions as requested by Billing Specialists.
- Provides oversight of medical records release requests, maintains patient charts for completeness and correct order, and keeps authorizations for release of medical records current in the file.
- Submits treatment plans as completed to appropriate Third Party Payers and maintains system to follow up on due dates of treatment plans.
- Consistent and regular attendance is a requirement of the position.
Non-Essential Functions/Other Duties : - Performs other tasks as assigned by Management.
Supervisory Responsibility : Not applicable.
Travel Required : Minimal.
Physical Demands : This is largely a sedentary role, with frequent sitting and computer keyboarding required. Some lifting (up to 35 pounds), stooping and bending are required.
Qualifications : Education: - High school diploma or equivalent, with coursework in medical insurance and/or billing preferred.
Experience: - At least two years of previous medical insurance, billing, or claims processing related experience.
- Experience working with the developmentally disabled or autistic spectrum clients is a plus.
Skills and Competencies: - Strong keyboarding and computer skills to include MS Office (Word and Excel) experience at an intermediate level.
- Knowledge of medical billing and ICD-10, and CPT coding, as well as knowledge of financial concepts.
- Knowledge of HIPPA privacy and security rules and regulations.
- Excellent interpersonal skills, with the ability to communicate effectively with others.
- Strong organizational skills, with the ability to multi-task and meet deadlines.
- Demonstrates initiative, with the ability to manage self and workload.
- Strong analytical and problem solving abilities.
- Exemplary customer service focus, for both internal and external clients.
- Strong team player.
- Displays professionalism and represents organization in a professional manner.
- Ability to abide by ethical guidelines and policies, including strict adherence to confidentiality and HIPPA guidelines.
Other: - Must be 18 years old or older.
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