Essential Duties and ResponsibilitiesInsurance Authorization Management
- Obtain and track insurance authorizations for evaluations and ongoing therapy services.
- Submit prior authorization requests, evaluations, care plans, and supporting documentation to insurance companies.
- Monitor authorization status and follow up with insurance providers as needed.
- Process authorization renewals and track upcoming expiration dates.
- Update authorization end dates based on communication logs and insurance correspondence.
- Prepare and send 3-day notification letters when required.
- Review and manage authorization denials.
- Conduct insurance follow-up calls regarding pending authorizations, claims, and eligibility issues.
- Assist with preparing and submitting appeals for denied services.
Patient Referrals and Intake Coordination
- Receive, process, and track incoming referrals.
- Send and receive referrals between providers, families, and insurance companies.
- Coordinate initial evaluations and re-evaluation scheduling.
- Send intake packets to parents and guardians.
- Follow up with families to ensure intake paperwork is completed, signed, and returned.
- Communicate with parents regarding referral status, authorizations, scheduling, and required documentation.
Medical Records and Documentation
- Maintain and update communication logs accurately and timely.
- Request signed reports, evaluations, and care plans from physicians' offices.
- Follow up with providers to obtain completed and signed documentation.
- Coordinate with therapists to ensure evaluations are completed and submitted promptly.
- Process patient discharges and maintain discharge documentation.
- Track progress reports requirements and ensure timely follow-up.
- Organize and maintain soft folders and electronic patient records.
- Manage baseline documentation and patient records.
- Move completed paperwork to scanning and ensure proper filing.
Communication and Follow-Up
- Serve as a liaison between families, therapists, physicians, and insurance companies.
- Make outbound calls to insurance providers, physician offices, and parents as needed.
- Document all communications accurately in the communication log.
- Ensure timely follow-up on pending authorizations, referrals, evaluations, and documentation requests.
Qualifications
- High school diploma or equivalent required.
- Minimum 1 year of medical office, healthcare administration, insurance authorization, or therapy clinic experience preferred.
- Knowledge of medical insurance verification, prior authorizations, and appeals processes preferred.
- Must speak Spanish
- Experience working with pediatric therapy, rehabilitation, or healthcare settings is a plus.
- Strong computer and data entry skills.
- Excellent organizational, time management, and multitasking abilities.
- Strong verbal and written communication skills.
- Ability to maintain confidentiality and comply with HIPAA regulations.
- Detail-oriented with the ability to work independently and as part of a team.
Language:
Work Location: In person
