Insurance Coordinator

About the role

Under the general guidance of the Director of Rehabilitation Services, responsible for leading outpatient therapy patient insurance eligibility and authorizations, ensuring accuracy and compliance for each individual. Responsible for implementing and teaching information related to admitting, billing, and insurance functions to other stakeholders, and delegating tasks when appropriate. Ensures accuracy with all aspects of outpatient therapy related to admitting, billing, and insurance.

Responsibilities

• Perform department daily scheduling, registration, and all insurance activities for outpatient rehabilitation services.
• Understand physical, occupational, and speech therapy services and utilize systems to ensure appropriate therapy CPT and ICD-10 codes are used.
• Review rehab denials and write-off reports and directly involve in the appeal processes.
• Monitor payer websites to maximize reimbursement based on services delivered.
• Perform pre-service check processes, including pre-authorization and medical necessity review as indicated by patient insurance carrier.
• Apply knowledge of specific payer payment rules to ensure timely claim resolutions.
• Review, provide, and submit additional information, including medical necessity and documentation for appeals, as necessary.

Requirements

• High school diploma or equivalent; knowledge of medical terminology is preferred.
• Associate degree in finance, accounting, business administration, or related field, or relatable experience.
• Experience within a hospital or clinic environment performing prior-authorizations and denial management, preferred.