CCM Billing & Insurance Referral Coordinator

Eventus WholeHealth Careers•Chapel Hill, NC

6d•Onsite

About The Position

At Eventus WholeHealth, we are transforming healthcare delivery within skilled nursing and assisted living facilities through an integrated, evidence based model. Since 2014, our mission has been to improve patient outcomes by providing comprehensive, whole person care supported by strong interdisciplinary collaboration. We partner closely with facilities, enhance clinical workflows, and support teams in delivering exceptional care to residents. Join a growing organization where your work directly strengthens care quality, clinician efficiency, and patient experience. Position Summary The CCM Billing & Insurance Referral Coordinator is responsible for reviewing, completing, and maintaining RFI reports related to Chronic Care Management (CCM) billing. This role also manages insurance referral and authorization requests through designated payer portals, helping ensure services are properly documented, submitted on time, and aligned with payer and organizational requirements.

Requirements

2 years' experience in healthcare setting
Computer skills and proficiency
Effective verbal and written communication skills
Highly organized with confidential client material, appointment tracking and caseload
Strong customer service skills, knowledge of geriatric population and patient navigation
Ability to work independently, deliver to deadlines, and effectively handle multiple priorities
Ability to solve problems with minimal direction
Great attention to detail and accuracy
Interest in working with geriatric clients

Nice To Haves

Experience in medical billing, revenue cycle, referrals, prior authorizations, care coordination, or healthcare administration preferred
Familiarity with CCM billing workflows, CPT coding concepts, insurance verification, and payer portal navigation

Responsibilities

Review RFI reports for CCM billing accuracy, completeness, and supporting documentation.
Research and resolve missing, inconsistent, or incomplete patient, provider, diagnosis, service, time-tracking, and billing information.
Complete and update RFI reports within established timelines and communicate unresolved issues to appropriate stakeholders.
Ensure CCM billing documentation complies with internal policies, payer requirements, and regulatory guidelines.
Submit, track, and document insurance referrals and prior authorization requests through designated payer portals.
Monitor referral and authorization statuses and follow up on pending, denied, expired, or incomplete requests.
Maintain accurate records of approvals, authorization numbers, referral details, supporting documentation, and effective dates.
Coordinate with providers, clinical teams, billing staff, and insurance representatives to resolve referral and billing issues.
Escalate denials, payer discrepancies, compliance concerns, and unresolved issues to management as appropriate.
Prepare reports and status updates regarding RFI completion, referral activity, authorization approvals, and outstanding follow-up items.
Other related duties as assigned.