Job Description

Peoples Injury Network Northwest, a brand partner of Upstream Rehabilitation, is looking for a Clinical Authorization Coordinator to join our team in Washington State, US

Are you looking for a position in a growing organization where you can make a significant impact on the lives of others? 

JOB SUMMARY: 

Responsible for working with clinic staff, insurance companies and relevant third parties regarding verification of benefits (VoB) and obtaining required authorization for treatment. Ensures accurate selection of insurance plan, documentation of benefits coverage, and submission of necessary pre-authorization and/or re-authorization to ensure no delay in reimbursement of treatment. Supports and contributes to the mission, vision and values of the company.

QUALIFICATIONS:

• High School Diploma or equivalent.
• 2 years medical clinical experience with an emphasis in workers compensation. 
• 1-year medical clinical experience.
• Excellent customer service and communication skills.
• Ability to multitask.
• Organizational detail.
• Ability to meet deadlines.
• Work with little to no supervision.
• Remote position. Will require some in person meeting time at the clinics

JOB FUNCTIONS:

• Reviews clinic rosters, patient electronic health record and verification of benefits completed by 3rd party (Guidehouse) for all patients.
• Communicates with payors to obtain any clarifications on the verification of benefits.
• Maintains positive payor relationships.
• Works with payors to obtain prior- and re-authorizations as required by the patient plan of care and payor.
• Handles documents and records related to patient insurance benefits and required authorizations and submits to payors accordingly.
• Manages requests to ensure prior authorizations are submitted within timeline guidelines.
• Follows up with payors to check the status of previously submitted authorizations.
• Processes authorization appeals for the appropriate patients.
• Works with back-end revenue cycle to understand and address authorization issues that may lead to downstream denials or write-offs.
• Reverifies insurance and authorization if needed for the crossover process (EOY insurance changes).
• Handles patients that have a change in payor during their plan of care as indicated by the payor overlap form submitted by an Office Coordinator.
• Maintains a working understanding of insurance benefits and seeks assistance as necessary.
• Attend weekly clinic staffing meetings, virtual or in person.

Fulltime positions include:

• Annual paid Charity Day to give back to a cause meaningful to you
• Medical, Dental, Vision, Life, Short-Term and Long-Term Disability Insurance
• 3-week Paid Time Off plus paid holidays
• 401K + company match

Physical Requirements: 

• This position is subject to inside environmental conditions: protections from weather conditions but not necessarily from temperature changes; exposed to noise consistent with indoor environment.
• This is a full-time position operating within normal business hours Monday through Friday, with an expectation of minimum of 40 hours per week; May be required to attend special events some evenings and weekends, or work additional hours as needed.
• This position is subject to sedentary work.
• Constantly sits, with ability to interchange with standing as needed.
• Constantly communicates with associates, must be able to hear and speak to accurately exchange information in these situations.
• Frequently operates a computer and other office equipment such as printers, phone, keyboard, mouse and copy machines using gross and fine manipulation.
• Constantly uses repetitive motions to type.
• Must be able to constantly view computer screen (near acuity) and read items on screen.
• Must have ability to comprehend information provided, use judgement to appropriately respond in various situations.
• Occasionally walks, stands, pushes or pulls 0-20 lbs., lifts 0-20 lbs. from floor to waist; carries, pushes, and pulls 0-20 lbs.
• Rarely crawls, crouches, kneels, stoops, climbs stairs or ladders, reaches above shoulder height, lifts under 10 lbs. from waist to shoulder.

This job description is not an all-inclusive list of all duties that may be required of the incumbent and is subject to change at any time with or without notice. Incumbents must be able to perform the essential functions of the position satisfactorily and that, if requested, reasonable accommodations may be made to enable associates with disabilities to perform the essential functions of their job, absent undue hardship.

Please do not contact the clinic directly.

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