RCM Coordinator - Insurance Verification

Metrocare Services•Dallas, TX

20d•Hybrid

About The Position

Are you looking for a purpose-driven career? At Metrocare, we serve our neighbors with developmental or mental health challenges by helping them find lives that are meaningful and satisfying. Metrocare is the largest provider of mental health services in North Texas, serving over 55,000 adults and children annually. For over 50 years, Metrocare has provided a broad array of services to people with mental health challenges and developmental disabilities. In addition to behavioral health care, Metrocare provides primary care centers for adults and children, services for veterans and their families, accessible pharmacies, housing, and supportive social services. Alongside clinical care, researchers and teachers from Metrocare’s Altshuler Center for Education & Research are advancing mental health beyond Dallas County while providing critical workforce to the state. Job Description: GENERAL DESCRIPTION The mission of Metrocare Services is to serve our neighbors with developmental or mental health challenges by helping them find lives that are meaningful and satisfying. We are an agency committed to quality gender-responsive, trauma-informed care to individuals experiencing serious mental illness, development disabilities, and co-occurring disorders. Metrocare programs focus on the issues that matter most in the lives of the children, families and adults we serve. RCM Coordinator - Insurance Verification ensures that clients served by Metrocare have accurate, up-to-date coverage and financial eligibility on file for primary care, behavioral health, IDD, ECI, ABA therapy, and LIDDA services. This position plays a critical role in reducing claim denials and maintaining financial sustainability by verifying benefits, monitoring payer eligibility, and coordinating with internal teams to resolve coverage issues before services are rendered.

Requirements

Required: High school diploma or GED; at least 5 years of experience in medical billing, claims processing, or revenue cycle management.
Analytical skills, professional acumen, business ethics, thorough understanding of continuous improvement processes, problem solving, respect for confidentiality, and excellent communication skills.
Knowledge of Medicaid, Medicare, MCO, and commercial eligibility requirements.
Understanding of eligibility processes specific to HCBS waivers, LIDDA programs, ECI, and behavioral health services.
Ability to interpret coverage limits, exclusions, and tiered benefits for multiple service types.
Knowledge of insurance benefit structures, prior authorization processes, and payer-specific verification rules.
Strong organizational and analytical skills.
Excellent verbal and written communication skills.
Ability to work independently and manage multiple tasks with attention to detail.
Professionalism and respect for confidentiality when handling sensitive client and payer information.
Basic math skills required.
Ability to work with reports and numbers & Ability to calculate moderately complex figures and amounts to accurately report activities and budgets.
Ability to apply common sense understanding to carry out simple one or two-step instructions.
Strong reasoning and problem-solving skills with the ability to make informed decisions in a dynamic and client-centered environment.
Use computer, printer, and software programs necessary to the position (i.e., Word, Excel, Outlook, and PowerPoint).
Ability to utilize Internet for resources.

Nice To Haves

Preferred: Associate’s degree in healthcare administration, business, or related field; prior experience in insurance verification, authorizations, or benefits coordination within healthcare or behavioral health settings.
A bachelor's degree will be accepted in place of experience.

Responsibilities

Verify patient eligibility and insurance benefits through payer portals, clearinghouses, and direct payer communication.
Conduct ongoing eligibility checks for Medicaid, Medicare, Managed Care Organizations (MCOs), and commercial insurance.
Ensure coverage is properly linked in the system for all service lines, including Primary Care, Behavioral Health, IDD, ECI, ABA Therapy, and LIDDA.
Monitor for lapses in eligibility and proactively communicate with clients and program staff to minimize service interruptions.
Verify insurance coverage and benefits prior to client appointments using payer portals, clearinghouses, and direct payer contact.
Obtain and track pre-authorization numbers, service approvals, and re-authorization renewals when applicable.
Confirm service-level coverage, including visit limits, co-pays, deductibles, and prior authorization requirements.
Assist families with Medicaid applications, renewals, and eligibility-related documentation as needed.
Document eligibility status, coverage changes, and updates in the electronic health record (EHR) or billing system.
Coordinate with RCM Claims staff to prevent claim denials related to coverage.
Prepare reports on eligibility status, payer trends, and at-risk clients for management review.
Performs other duties as assigned.