Revenue Cycle Coordinator

LLA Therapy•Fairlawn, OH

20h•Onsite

About The Position

We are looking for an experienced, detail-oriented Revenue Cycle Coordinator to join our growing pediatric therapy team. This role focuses on insurance verification and benefits, prior authorizations, claim denials and appeals. The right candidate is more than someone who can work a billing queue. We are looking for a problem solver who takes ownership, asks questions, researches issues, and follows them through to resolution.

Requirements

High school diploma or GED required.
Experience in medical billing, insurance verification, prior authorizations, denial management, or healthcare administration.
Understanding of CPT codes, medical terminology, insurance terminology, and healthcare billing processes.
Experience working with insurance company websites and payer portals.
Strong attention to detail and excellent organizational skills.
Strong written and verbal communication skills.
Excellent problem-solving and critical-thinking skills.
Ability to manage multiple priorities and meet deadlines.
Comfortable communicating directly with insurance companies.
Self-motivated and able to work independently.
Team-oriented and willing to collaborate across departments.
Resourceful and willing to think outside the box when solving problems.
Comfortable learning new software, systems, and payer processes.

Nice To Haves

Knowledge of commercial insurance and/or Medicaid managed care preferred.

Responsibilities

Verify patient benefits - deductibles, co-pays, co-insurance, visit limits, authorization requirements, and other limitations before services begin and throughout treatment.
Review coverage for outpatient services (occupational, physical, and speech therapy).
Identify potential coverage issues that could affect patient services or reimbursement.
Maintain accurate and up-to-date insurance information.
Communicate benefit information clearly and professionally with families and internal team members.
Research and resolve discrepancies between verified benefits and actual claim processing.
Obtain initial prior authorizations for therapy services.
Submit clinical documentation and supporting information to insurance companies.
Monitor authorization units, approved dates, and expiration dates.
Proactively request authorization renewals before existing authorizations expire.
Follow up with insurance companies regarding pending authorization requests.
Communicate authorization status to therapists, scheduling staff, and others as needed.
Identify and resolve authorization-related issues that may impact claims or patient services.
Review denied and rejected claims and determine the reason for non-payment.
Research payer policies, claim history, eligibility, authorization records, and documentation to identify the root cause of denials.
Determine the appropriate resolution, including claim correction, resubmission, appeal, or payer follow-up.
Prepare and submit appeals with appropriate supporting documentation.
Contact insurance companies to research and resolve complex claim issues.
Track outstanding denials and follow up consistently through resolution.
Identify recurring denial trends and communicate them to leadership.
Work collaboratively with billing, scheduling, and clinical teams to prevent issues.