Insurance Ver & Auth Coordinator

Job Summary

The Insurance Verification & Authorization Coordinator ensures patients are financially cleared for services prior to treatment through comprehensive insurance eligibility verification, benefits investigation, prior authorization management, and patient financial counseling. This role serves as a liaison between patients, providers, insurance carriers, and internal departments to facilitate timely access to care while maximizing reimbursement and minimizing claim denials.

Key Responsibilities

• Verify insurance eligibility, coverage, and benefits for all scheduled patients prior to services.
• Investigate and document deductible, coinsurance, copayment, out-of-pocket maximum, authorization, referral, and network participation requirements.
• Accurately enter and maintain patient demographic and insurance information within the electronic health record (EHR) and practice management system - NextGen.
• Identify coverage issues and proactively contact patients, insurance carriers, or referral sources to obtain updated information.
• Communicate patient financial responsibility estimates when applicable.
• Ensure all required insurance and demographic information is obtained prior to the patient's first appointment.
• Initiate, submit, track, and obtain prior authorizations and referrals for behavioral health and medical services.
• Maintain current knowledge of payer-specific authorization guidelines, medical necessity requirements, and clinical policies.
• Escalate authorization concerns that may impact patient care or reimbursement.
• Educate patients regarding insurance coverage, benefits, authorization requirements, and financial responsibility.
• Discuss copays, deductibles, coinsurance, and out-of-pocket obligations in a clear and professional manner.
• Collect patient payments and process credit card transactions in accordance with company policies.
• Aid in resolving eligibility and authorization issues.
• Respond promptly to telephone, voicemail, email, fax, and electronic inquiries from patients, providers, insurance carriers, and internal departments.
• Collaborate with intake, clinical, billing, and revenue cycle teams to resolve eligibility and authorization issues.
• Identify and resolve front-end revenue cycle issues that could result in claim denials or delayed reimbursement.
• Review payer requirements and communicate changes that impact patient access, reimbursement, or operational workflows.
• Maintain accurate account notes and documentation of all payer and patient communications.
• Aid in denial prevention efforts by ensuring eligibility and authorization requirements are met prior to service.
• Monitor assigned work queues and productivity metrics to ensure timely completion of tasks.

Preferred Experience & Qualifications

• Minimum of 3–5 years of experience in healthcare insurance verification, patient access, prior authorizations, medical billing, or revenue cycle operations required; behavioral health experience strongly preferred.
• High school diploma or equivalent required.
• Strong understanding of insurance eligibility verification, benefits investigation, referrals, and prior authorization processes.
• Working knowledge of revenue cycle operations and denial prevention strategies.
• Experience working with Medicare, Medicaid, commercial insurance plans, and managed care organizations required.
• Proven ability to identify billing trends, troubleshoot issues, and recommend process improvements.
• Familiarity with payer regulations, reimbursement methodologies, and compliance requirements, including CMS and HIPAA.
• Working knowledge of electronic health record (EHR) and practice management systems, preferably NextGen.
• Familiarity with medical terminology, CPT codes, diagnosis codes, and payer requirements.
• Proficiency in Microsoft Office Suite, including Outlook, Excel, and Word.
• Excellent organizational skills with the ability to manage multiple priorities and deadlines.
• Strong analytical and problem-solving abilities.
• Exceptional verbal and written communication skills.
• Ability to maintain accuracy and attention to detail in a fast-paced environment.
• Ability to work independently while collaborating effectively with cross-functional teams.
• Knowledge of clearinghouse platforms (e.g., Waystar) is a plus.

Physical Demands

While performing the duties of this job, the employee is regularly required to stand, walk, and talk or hear. The employee frequently is required to use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; and climb or balance. The employee is occasionally required to sit and stoop, kneel, crouch, or crawl. The employee must frequently lift and/or move up to 50 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

Benefits

• 401(k)
• Medical, Dental, and Vision Insurance
• Paid Time Off
• Tuition reimbursement
• Employee discounts on gym memberships, cell phone packages, hotels, rental cars, computers, amusement parks, theater tickets, and more!