Insurance Authorization Coordinator

United Counseling and Support Services•Upper Marlboro, MD

9d•$0 - $21

About The Position

The Insurance Authorization Coordinator is a part-time independent contractor responsible for coordinating, tracking, and following up on insurance authorizations for behavioral health services. The primary focus of this role is to help ensure that initial authorization requests, reauthorizations, continued-service requests, and supporting documentation are completed accurately and within applicable payer timeframes. The contractor will communicate with insurance companies, managed care organizations, clinical staff, billing personnel, and program leadership as necessary to support continuity of authorized services. In addition to authorization responsibilities, the contractor may facilitate approved behavioral health or rehabilitation groups and may maintain a limited Psychiatric Rehabilitation Program (PRP) caseload based on program needs, qualifications, credentialing requirements, and available contracted hours. Insurance authorization responsibilities are the primary function of this contract position. Group facilitation and PRP services are secondary responsibilities and will be assigned based on program needs and the contractor's available service hours.

Requirements

High school diploma or equivalent required
Strong organizational and time-management skills.
Excellent attention to detail and ability to manage multiple authorization deadlines.
Strong written and verbal communication skills.
Ability to communicate professionally with insurance representatives, clinical staff, billing personnel, clients, and program leadership.
Ability to maintain confidentiality and appropriately handle protected health information.
Must satisfy applicable credentialing, training, payer, program, and regulatory requirements for any direct behavioral health or PRP services provided.

Nice To Haves

Associate's or bachelor's degree in behavioral health, human services, psychology, social work, healthcare administration, or a related field preferred.
Previous experience with healthcare insurance authorizations, behavioral health services, medical administration, billing, utilization management, or related work preferred.
Behavioral health or human services experience preferred.
Familiarity with Medicaid, Medicare, commercial insurance, and managed care organizations preferred.
Experience with electronic health record (EHR) systems preferred.
Group facilitation and/or PRP experience is a plus.

Responsibilities

Coordinate initial insurance authorizations, prior authorizations, reauthorizations, and continued-service requests.
Monitor authorization effective dates, expiration dates, approved units, visits, days, and service limitations.
Maintain an accurate authorization tracking system for assigned clients.
Proactively identify authorizations approaching expiration or exhaustion.
Coordinate with clinical staff to obtain assessments, treatment plans, progress notes, and other documentation needed for authorization requests.
Submit authorization and reauthorization requests within required payer timeframes.
Follow up with insurance companies and managed care organizations regarding pending requests.
Document authorization numbers, approval dates, service periods, approved units, and other relevant information.
Promptly communicate approvals, denials, requests for additional information, and other authorization issues to appropriate team members.
Assist with reconsiderations, appeals, and authorization denials by coordinating required documentation.
Coordinate with billing personnel regarding authorization-related billing concerns.
Identify potential authorization gaps and promptly communicate concerns to program leadership.
Maintain accurate records of authorization activities and follow-up efforts.
Maintain confidentiality of client information and comply with HIPAA, organizational privacy requirements, and applicable contractual requirements.
Facilitate or co-facilitate approved behavioral health, psychoeducational, rehabilitation, life-skills, wellness, or PRP groups (as assigned).
Prepare appropriate group activities and educational materials (as assigned).
Promote client participation and maintain a professional and supportive group environment (as assigned).
Complete required group documentation within established timeframes (as assigned).
Communicate significant client concerns to appropriate clinical or program leadership (as assigned).
Provide group services only within the contractor's qualifications, credentials, training, and applicable program requirements (as assigned).
Provide rehabilitation and support services consistent with each client's individualized rehabilitation goals (as assigned).
Maintain appropriate contact with assigned clients (as assigned).
Assist clients with developing independent living, coping, social, communication, community integration, and other rehabilitation skills (as assigned).
Coordinate with therapists, healthcare providers, community resources, and other members of the client's treatment team when appropriate (as assigned).
Monitor and document progress toward rehabilitation goals (as assigned).
Complete progress notes and required PRP documentation within established timeframes (as assigned).
Participate in case reviews, care coordination, and other required program activities (as assigned).
Promptly report significant client concerns or changes in functioning according to organizational procedures (as assigned).