ABOUT THE ORGANIZATION We provide Intensive Outpatient (IOP) and Partial Hospitalization (PHP) programming for adolescents ages 10–17 in Apex, NC. We contract with BCBS NC, UnitedHealthcare/Optum, Aetna, and Cigna/Evernorth, and operate Ritten EMR with Availity and Waystar for authorizations and revenue cycle. Our team is small, fast-moving, and focused on making sure no clinically appropriate admission is lost to a process failure.
Job Overview
We are seeking a dynamic and detail-oriented Admissions Coordinator to join our teen mental health team. In this vital role, you will serve as the first point of contact for prospective patients, guiding them through the admissions process with enthusiasm and professionalism. Your energetic approach will help create a welcoming environment, ensuring smooth patient intake and administrative support to facilitate exceptional patient experiences. This paid position offers an exciting opportunity to contribute to a thriving healthcare setting while honing your skills in medical office operations. THE ROLE We need a sharp, self-directed UR/PA Coordinator who can own the authorization pipeline end-to-end — from initial submission through appeals — across our IOP and PHP service lines. This is not a data-entry role. You will work directly with our clinical and billing teams to ensure every active client has a valid, current authorization, and that no clinically appropriate admission is lost to a process failure.
Duties
- Greet and assist patients, visitors, and staff with warmth and professionalism, establishing a positive first impression. Explain the benefit of IOP and our program offerings of DBT, CBT, polyvagal theory
- Manage patient intake by collecting accurate personal, insurance, and medical information efficiently
- Verify insurance details and coordinate with insurance providers to ensure proper coverage, deductibles, denials and experience with accounts receivables in RCM system
- Schedule appointments, follow-up visits, and coordinate with medical staff to optimize patient flow
- Maintain organized records of patient information, appointments, and admission documentation
- Support medical administrative tasks such as data entry, filing, and correspondence
- Collaborate with clinical teams to ensure all necessary documentation is complete for patient admissions
CORE RESPONSIBILITIES
- Submit initial prior authorization requests for IOP and PHP admissions across BCBS NC, UHC/Optum, Aetna, and Cigna/Evernorth in a timely manner
- Conduct concurrent review submissions at required intervals; document clinical justification aligned to medical necessity criteria and payer-specific guidelines
- Track authorization status in Waystar and our internal authorization log; flag gaps and expiring auths proactively
- Coordinate peer-to-peer calls between our Clinical Director and payer Medical Directors when initial requests are denied
- Prepare and submit Level I and Level II appeals with supporting clinical documentation; maintain denial reason tracking
- Liaise with Ritten EMR to ensure documentation supports authorization requests (treatment plans, group notes, assessments)
- Communicate authorization updates to the clinical team and update Ritten accordingly
- Maintain compliance with all HIPAA privacy and security standards in every communication and workflow
- Generate weekly UR dashboard reports: auth approval rates, average turnaround time, denial rates by payer, and outstanding appeals
REQUIREMENTS Non-Negotiable
- Minimum 3 years of UR/PA experience in behavioral health
- Demonstrated experience working with commercial payers (BCBS, UHC/Optum, Aetna, or Cigna) — NC experience a plus
- Working knowledge of medical necessity criteria for adolescent IOP/PHP levels of care
- Proven ability to write clinical justification narratives that win authorizations and appeals
- Comfortable operating independently in a remote environment with minimal supervision
Preferred Qualifications
- Experience in Ritten EMR
- Waystar / RCM platform familiarity
- Availity portal proficiency
- CPUR, CPHQ, or similar certification
- Background in adolescent behavioral health or IOP/PHP clinical operations
- Strong Google Sheets / Excel skills
- Familiarity with ICD-10 and H-code billing
WORKING EXPECTATIONS
- Availability: Must be reachable during core hours (8AM – 5PM ET, Mon–Fri) for time-sensitive auth requests and peer-to-peer coordination
- Turnaround: Initial authorization submissions completed within 24 hours of referral; concurrent reviews submitted no later than 48 hours before current auth expiration
- Communication: Weekly status update via our internal platform; escalation of urgent denials within 2 business hours
- Tools: Must have reliable internet, HIPAA-compliant workstation, and ability to access web-based portals (Ritten, Waystar, Availity, payer portals)
- BAA: Must be willing to sign a Business Associate Agreement prior to start
HOW TO APPLY Submit a proposal that directly addresses the following. Generic cover letters will not be reviewed.
- Describe your experience submitting prior authorizations for IOP or PHP programs — which payers, what volume, and what your approval rate was.
- Walk us through how you handle a concurrent review denial from a payer. What is your process?
- Have you worked with Ritten or Waystar? If so, describe specifically how you used each platform in a UR context.
- What does your current availability look like, and how many active clients or accounts can you manage simultaneously?
Join us as an Admissions Coordinator & Insurance Verfications and be part of a passionate team dedicated to delivering outstanding healthcare experiences. Your energy, attention to detail, and commitment will make a meaningful difference in the lives of our patients while advancing your career in the medical administrative field.
Work Location: In person
