Insurance Verification & Authorization Coordinator

About the role

The Insurance Verification & Authorization Coordinator is responsible for verifying insurance coverage, securing prior authorizations, and assisting patients in understanding their financial responsibilities.

Responsibilities

• Verify insurance eligibility, benefits, deductibles, copays, and coinsurance before scheduled appointments.
• Review coverage requirements, referrals, prior authorizations, and network participation to ensure patients are financially cleared.
• Accurately maintain patient demographics and insurance information within NextGen.
• Contact insurance carriers, patients, and referral sources to resolve eligibility or coverage discrepancies.
• Submit, monitor, and obtain prior authorizations for behavioral health and medical services while tracking authorization expirations and visit utilization.
• Explain insurance benefits and anticipated out-of-pocket costs to patients in a professional and compassionate manner.
• Collect patient payments and assist with payment arrangements or financial assistance when appropriate.
• Work closely with Intake, Clinical, Billing, and Revenue Cycle teams to resolve issues that could delay treatment or reimbursement.
• Help identify opportunities to reduce denials and improve front-end revenue cycle processes.

Requirements

• At least 3 years of experience in insurance verification, patient access, prior authorizations, medical billing, or revenue cycle operations.
• Behavioral health experience is highly preferred.
• Strong understanding of Medicare, Medicaid, commercial insurance, and managed care plans.
• Experience verifying eligibility, researching benefits, and obtaining prior authorizations.
• Working knowledge of medical terminology, CPT and ICD coding, and payer requirements.
• Experience with NextGen or a similar electronic health record/practice management system is preferred.
• Familiarity with clearinghouse platforms such as Waystar is a plus.

Qualifications

• Bachelor's degree in healthcare administration, business, or a related field.
• Knowledge of healthcare regulations and compliance standards.
• Excellent communication and interpersonal skills.
• Ability to work independently and manage multiple tasks simultaneously.

Skills

• Proficient in medical terminology and coding systems.
• Strong organizational and time management skills.
• Effective problem-solving and decision-making abilities.
• Ability to work well under pressure and meet deadlines.

Benefits

• This position may be eligible for medical, dental, vision, and 401(k).