Clinical Authorization Coordinator

Summary

Join Peoples Injury Network Northwest as a Clinical Authorization Coordinator! This remote position, based in Washington State, involves collaborating with clinic staff, insurance companies, and third parties to verify benefits and obtain treatment authorizations. You will ensure accurate insurance selection, document coverage, and submit pre-authorization requests to prevent treatment reimbursement delays. The role contributes to the company's mission and values. Responsibilities include reviewing patient records, communicating with payors, maintaining positive relationships, and managing authorization requests and appeals. You will also work with the revenue cycle team to address authorization issues. This full-time position offers a comprehensive benefits package.

Requirements

• High School Diploma or equivalent
• 2 years medical clinical experience with an emphasis in workers compensation
• 1-year medical clinical experience
• Excellent customer service and communication skills
• Ability to multitask
• Organizational detail
• Ability to meet deadlines
• Work with little to no supervision
• Remote position. Will require some in person meeting time at the clinics

Responsibilities

• Reviews clinic rosters, patient electronic health record and verification of benefits completed by 3rd party (Guidehouse) for all patients
• Communicates with payors to obtain any clarifications on the verification of benefits
• Maintains positive payor relationships
• Works with payors to obtain prior- and re-authorizations as required by the patient plan of care and payor
• Handles documents and records related to patient insurance benefits and required authorizations and submits to payors accordingly
• Manages requests to ensure prior authorizations are submitted within timeline guidelines
• Follows up with payors to check the status of previously submitted authorizations
• Processes authorization appeals for the appropriate patients
• Works with back-end revenue cycle to understand and address authorization issues that may lead to downstream denials or write-offs
• Reverifies insurance and authorization if needed for the crossover process (EOY insurance changes)
• Handles patients that have a change in payor during their plan of care as indicated by the payor overlap form submitted by an Office Coordinator
• Maintains a working understanding of insurance benefits and seeks assistance as necessary
• Attend weekly clinic staffing meetings, virtual or in person

Benefits

• Annual paid Charity Day to give back to a cause meaningful to you
• Medical, Dental, Vision, Life, Short-Term and Long-Term Disability Insurance
• 3-week Paid Time Off plus paid holidays
• 401K + company match