Insurance Authorization Coordinator in Upper Marlboro, Maryland at United Counseling and Support Services

Department: PHP
Engagement Type: Independent Contractor
Service Commitment: Up to 15 Hours Per Week

The Insurance Authorization Coordinator is a part-time independent contractor responsible for coordinating, tracking, and following up on insurance authorizations for behavioral health services.

The primary focus of this role is to help ensure that initial authorization requests, reauthorizations, continued-service requests, and supporting documentation are completed accurately and within applicable payer timeframes. The contractor will communicate with insurance companies, managed care organizations, clinical staff, billing personnel, and program leadership as necessary to support continuity of authorized services.

In addition to authorization responsibilities, the contractor may facilitate approved behavioral health or rehabilitation groups and may maintain a limited Psychiatric Rehabilitation Program (PRP) caseload based on program needs, qualifications, credentialing requirements, and available contracted hours.

Insurance authorization responsibilities are the primary function of this contract position. Group facilitation and PRP services are secondary responsibilities and will be assigned based on program needs and the contractor's available service hours.

The contractor will:

• Coordinate initial insurance authorizations, prior authorizations, reauthorizations, and continued-service requests.

• Monitor authorization effective dates, expiration dates, approved units, visits, days, and service limitations.

• Maintain an accurate authorization tracking system for assigned clients.

• Proactively identify authorizations approaching expiration or exhaustion.

• Coordinate with clinical staff to obtain assessments, treatment plans, progress notes, and other documentation needed for authorization requests.

• Submit authorization and reauthorization requests within required payer timeframes.

• Follow up with insurance companies and managed care organizations regarding pending requests.

• Document authorization numbers, approval dates, service periods, approved units, and other relevant information.

• Promptly communicate approvals, denials, requests for additional information, and other authorization issues to appropriate team members.

• Assist with reconsiderations, appeals, and authorization denials by coordinating required documentation.

• Coordinate with billing personnel regarding authorization-related billing concerns.

• Identify potential authorization gaps and promptly communicate concerns to program leadership.

• Maintain accurate records of authorization activities and follow-up efforts.

• Maintain confidentiality of client information and comply with HIPAA, organizational privacy requirements, and applicable contractual requirements.

Based on qualifications, program needs, and available contracted hours, the contractor may:

• Facilitate or co-facilitate approved behavioral health, psychoeducational, rehabilitation, life-skills, wellness, or PRP groups.

• Prepare appropriate group activities and educational materials.

• Promote client participation and maintain a professional and supportive group environment.

• Complete required group documentation within established timeframes.

• Communicate significant client concerns to appropriate clinical or program leadership.

• Provide group services only within the contractor's qualifications, credentials, training, and applicable program requirements.

The contractor may be assigned a limited PRP caseload based on program needs, qualifications, credentialing requirements, and available contracted hours.

PRP responsibilities may include:

• Provide rehabilitation and support services consistent with each client's individualized rehabilitation goals.

• Maintain appropriate contact with assigned clients.

• Assist clients with developing independent living, coping, social, communication, community integration, and other rehabilitation skills.

• Coordinate with therapists, healthcare providers, community resources, and other members of the client's treatment team when appropriate.

• Monitor and document progress toward rehabilitation goals.

• Complete progress notes and required PRP documentation within established timeframes.

• Participate in case reviews, care coordination, and other required program activities.

• Promptly report significant client concerns or changes in functioning according to organizational procedures.

This is a part-time independent contractor position providing up to 15 hours of services per week, unless otherwise approved or specified in the contractor agreement.

Insurance authorization responsibilities are the primary priority of this engagement. Group facilitation and PRP assignments will be based on program needs and the contractor's capacity within the agreed-upon service commitment.

Any PRP caseload assigned to the contractor should remain limited enough to allow authorization responsibilities and required follow-up activities to be completed within the contracted service hours.

• High school diploma or equivalent required; associate's or bachelor's degree in behavioral health, human services, psychology, social work, healthcare administration, or a related field preferred.

• Previous experience with healthcare insurance authorizations, behavioral health services, medical administration, billing, utilization management, or related work preferred.

• Behavioral health or human services experience preferred.

• Familiarity with Medicaid, Medicare, commercial insurance, and managed care organizations preferred.

• Experience with electronic health record (EHR) systems preferred.

• Group facilitation and/or PRP experience is a plus.

• Strong organizational and time-management skills.

• Excellent attention to detail and ability to manage multiple authorization deadlines.

• Strong written and verbal communication skills.

• Ability to communicate professionally with insurance representatives, clinical staff, billing personnel, clients, and program leadership.

• Ability to maintain confidentiality and appropriately handle protected health information.

• Must satisfy applicable credentialing, training, payer, program, and regulatory requirements for any direct behavioral health or PRP services provided.

The contractor is expected to provide timely, accurate, and professional services, including:

• Maintaining current authorization records.

• Completing authorization and reauthorization submissions within required timeframes.

• Consistently following up on pending authorization requests.

• Promptly communicating authorization concerns and potential service gaps.

• Maintaining accurate documentation of authorization activities.

• Completing assigned group and PRP documentation within required timeframes.

• Managing any assigned PRP caseload without interfering with primary authorization responsibilities.

• Providing contracted services within the agreed-upon maximum of 15 hours per week unless additional services are authorized.

This position is intended to be performed under an independent contractor agreement. The specific terms of the contractor relationship, including compensation, invoicing, service expectations, confidentiality requirements, termination provisions, and other contractual obligations, will be governed by the executed contractor agreement.

Nothing in this job description is intended to modify the terms of the contractor agreement or independently determine the worker's legal classification. The actual working relationship and applicable federal and state requirements will govern contractor classification.

The responsibilities listed above describe the general scope of contracted services and are not intended to be exhaustive. Specific assignments may vary based on program needs, contractor qualifications, payer requirements, and the terms of the contractor agreement.