Billing Managed Care Coordinator

• High School Diploma or equivalent required.
• Associate or bachelor's degree in a related field preferred.
• 2-3 years of experience in managed care billing, authorizations, referrals, or revenue cycle operations required.

Knowledge, Skills, and Abilities:

• Knowledge of insurance authorization, referral, and reimbursement processes
• Familiarity with EPIC and payer verification systems (e.g., NEHEN) preferred
• Strong organizational skills with high attention to detail and accuracy
• Ability to analyze information, identify issues, and support resolution within established workflows
• Effective interpersonal and communication skills (phone, written, and in-person)
• Ability to manage multiple tasks and prioritize in a fast-paced environment
• Ability to work both independently and collaboratively within a team setting
• Proficiency in standard computer applications and healthcare systems
• Professional demeanor with ability to handle sensitive information with discretion

Key Responsibilities:

Authorization, Referral, and Eligibility Management

• Obtain insurance authorizations prior to initiation of patient services
• Ensure all required insurance referrals are received, complete, and accurately documented
• Perform demographic and insurance eligibility checks in EPIC, NEHEN, and other payer systems; update or escalate discrepancies
• Facilitate referral and prior authorization requests with payers and specialty pharmacies via phone, fax, and payer portals
• Maintain accurate and timely documentation of all authorization and referral activity in EPIC

Billing & Reimbursement Support

• Be up to date on rules and eligibility of patient plans from managed care organizations
• Monitor and take action on work queues related to missing authorizations, referrals, and denials. Must be done in appropriate timeframe to ensure it is done within the standard timeframe to resubmit.
• Partner with Lead managed care coordinator and/ or billing teams to resolve authorization- and referral-related denials and support reprocessing or appeals

Collections & Financial Coordination

• Support collection workflows for patient responsibility, including co-insurance, deductibles, and self-pay balances where applicable
• Assist in identifying and escalating payer or patient-related issues that may impact reimbursement

Operational Workflow Support

• Follow established department workflows and managed care processes
• Scan provider schedules for non-contracted plans and escalate issues to Practice Administrators or Lead Coordinator
• Maintain up-to-date tracking mechanisms and records of managed care activities (authorizations, referrals, denials)
• Participate in Department Appointment Review (DAR) follow-up activities where applicable
• Take direction from team lead and collaborate with team members to review, adopt and maintain workflows and best practice
• Serve as back up to other Billing managed care coordinators and other administrative staff

Collaboration & Communication

• Work closely with Practice Administrators, registration teams, billing staff, and clinical teams to ensure accurate information flow
• Communicate clearly with patients regarding authorization requirements, status updates, and responsibilities related to their care
• Serve as a resource for routine managed care process questions and escalate complex issues to the Lead Managed Care Coordinator
• Serve as back up to other staff

Process Improvement & Quality

• Identify workflow inefficiencies and communicate opportunities for improvement to the Lead and leadership team
• Support implementation of standardized workflows, tools, and best practices across sites
• Maintain working knowledge of payer policies, billing requirements, and system updates

Training & Documentation Support

• Support training and onboarding of new staff as directed by the Lead Managed Care Coordinator
• Adhere to and help maintain departmental policies, procedures, and workflow documentation

Other Duties

• Attend departmental and practice meetings as required
• Ensure compliance with all hospital, state, and federal regulations (including HIPAA and Joint Commission standards)
• Perform other duties as assigned, that may include but not limited to supporting provider(s)