Authorization & Eligibility Coordinator

Job Code: AEC - 108
Revision Date: August 26, 2026

Starting Salary: $17.83 hourly; $37,081.00 annually

FLSA: Non-Exempt

Overview

We are an agency committed to innovative behavioral health services in trauma-informed care that promote healing and recovery to instill a sense of empowerment and foster a lifelong sense of resilience.

General Description

This position is responsible for coordinating patient pre-registration, financial assessment, insurance eligibility verification, and authorization processes to ensure accurate billing, reimbursement, and compliance with payer and regulatory requirements.

This role ensures that all patients are appropriately financially screened, authorized for services, and informed of their financial responsibilities prior to service delivery.

The position works under general supervision, independently developing work methods and sequences, and reports directly to the Revenue Cycle Supervisor.

Duties and Responsibilities

The functions listed below are those that represent the majority of the time spent working in this position. Management may assign additional functions related to the type of work of the position, as necessary.

• Reviews, verifies, and updates patient account and medical record information to ensure accurate assignment of funding sources, including Medicaid, Medicare, commercial insurance, private pay, and other special funding programs.
• Demonstrates knowledge of payer-specific requirements and applies established policies and procedures to support compliance, reimbursement, and accurate patient financial records.
• Reviews and validates patient and subscriber demographic, financial, insurance, and eligibility information to ensure the accuracy, completeness, and compliance of financial assessments including required signatures and supporting documentation in accordance with organizational, payer, and regulatory requirements.
• Monitor expiring financial assessments and eligibility documentation and facilitate timely updates to maintain compliance with federal and state requirements.
• Oversees compliance with charity care, financial assistance, and ensuring consistent application of eligibility criteria, documentation standards, and regulatory requirements while supporting patient financial services objectives.
• Updates patient account information and facilitates reassessments when changes in financial circumstances, insurance coverage, or eligibility status are identified.
• Oversees and facilitates authorization and benefit verification processes by collaborating with insurance payers and third-party entities to secure required approvals, validate coverage and reimbursement requirements, and support access to services.
• Ensures the accuracy and integrity of authorization records, monitors approvals and expiration dates, coordinates follow-up activities, and maintains compliance with payer guidelines.
• Assist and establish payment arrangements, ensuring all agreements are accurately documented as needed.
• Serves as a primary liaison with clients and clinic/program staff, utilizing telephone and approved communication channels to address discrepancies of eligibility, explain authorization requirements, clarifying coverage limitations, and resolve financial responsibility concerns.
• Collaborates with insurance carriers, managed care organizations, and third-party payers to investigate and resolve claim-related issues/denials regarding authorization discrepancies, eligibility conflicts, and coverage determinations.
• Maintains accurate documentation of payer communications, analyzes claim outcomes, and initiates reprocessing, reconsideration, or corrective action requests when errors, discrepancies, or updated information impact claim adjudication and reimbursement.
• Assist clinic staff and/or Revenue Cycle teams with researching alternative funding sources or coverage options to facilitate reimbursement and maintain continuity of services.
• Reviews patient accounts, including private pay, Monthly Ability to Pay (MAP), and other outstanding balance accounts, to ensure charges, payments, adjustments, and balances are accurately reflected.
• Identifies discrepancies affecting private pay account balances, supports account reconciliation activities, and collaborates with appropriate departments to facilitate the timely resolution of outstanding financial obligations.
• Ensures compliance with payer requirements, regulatory standards, and organizational policies.
• Supports quality improvement efforts and corrective action planning.
• Provides staff training on authorization and financial processes while maintaining strict confidentiality of patient and organizational information.
• Performs other duties as assigned.

Minimum Education and Experience Requirements

Requires High School graduation or GED equivalent, Associate degree preferred. Supplemented by a minimum of two (2) years of experience in healthcare registration, insurance verification, billing, or related field; or equivalent combination of education and experience.

· Experience in medical or behavioral health eligibility and authorization processes preferred.

• Knowledge of various insurance plans (HMO, PPO, Medicare, Medicaid) and payors, preferred.

• Working knowledge of MS office (MS Word, Excel, and Outlook), preferred.

• Training or educational background with medical terminology and familiarity with ICD coding preferred.

• Understanding of financial counseling, patient billing, and collections procedures.

Experience with trauma-informed services; cognitive behavioral therapies, including Dialectical Behavioral Therapy (DBT); and motivational therapies including the use of incentives, preferred.

Required Knowledge and Abilities

Knowledge of trauma-informed theories, principals, and practices (includes multi-faceted understanding of concepts such as community trauma, intergenerational and historical trauma, parallel processes, and universal precautions), preferred.

Physical Demands

Performs sedentary work that involves walking or standing some of the time and involves exerting up to 10 pounds of force on a regular and recurring basis or sustained keyboard operations.

Unavoidable Hazards (Work Environment)

• Involves routine and frequent exposure to:
• Bright/dim light; Dusts and pollen.
• Extreme heat and/or cold; Wet or humid conditions.
• Extreme noise levels, Animals/wildlife.
• Vibration; Fumes and/or noxious odors.
• Traffic; Moving machinery.
• Electrical shock; Heights.
• Radiation; Disease/pathogens.
• Toxic/caustic chemicals; Explosives; Violence.
• Other extreme hazards not listed above.

Special Certifications and Licenses

• Certified Healthcare Access Associate (CHAA) preferred within the time limit designated by EHN.
• Must possess and maintain a valid state Driver's License with an acceptable driving record.
• Must be able to pass a TB, criminal background, and drug screen.

Americans with Disabilities Act Compliance (ADA)

Emergence Health Network is an Equal Opportunity Employer. ADA requires Emergence Health Network to provide reasonable accommodations to qualified persons with disabilities. Prospective and current employees are encouraged to discuss ADA accommodations with management.

Other Job Characteristics

• Staffing requirements, including criteria that staff have diverse disciplinary backgrounds, have necessary State required license and accreditation, and are culturally and linguistically trained to serve the needs of the clinic's patient population.
• Credentialed, certified, and licensed professionals with adequate training in person-centered, family-centered, trauma informed, culturally-competent and recovery-oriented care.
• Responsible for adhering to the EHN common purpose and service framework to continuously provide exceptional care to all constituents.

Note: This Class Description does not constitute an employment agreement between the Emergence Health Network and an employee and is subject to change by the Emergence Health Network as its needs change.