Authorization Coordinator

Availability: Full-time with at least two (2) days until 6pm

Job Summary

The Authorization Coordinator manages authorization, referral, and benefits processes to help ensure continuity of client services. This role coordinates with families, therapists, physicians, insurance companies, regional centers, and internal teams to obtain, submit, track, and maintain required documentation and authorizations.

The coordinator proactively monitors deadlines and renewals, follows up on outstanding requirements, supports insurance changes, and helps prevent authorization-related service interruptions. This position also provides backup administrative support to the Account Manager as needed.

Essential Duties and Responsibilities

Therapist Reports & Authorization Requests

• Monitor incoming therapist reports and review them for required authorization and referral actions.
• Download therapist reports into the appropriate client profile and maintain accurate and organized documentation.
• For Kaiser clients, save both PDF and Word versions of required reports and submit appropriate documentation for authorization approval.
• For HealthNet and Anthem clients, submit therapist reports, authorization request forms, and required PCP referrals for new authorizations.
• For Physmetrics clients, fax therapist reports with completed authorization forms and required therapist signatures.
• For CVRC clients, submit reports and request new Plans of Service (POS), including confirmation of authorization dates and available units.
• Send required documentation to CVRC caseworkers using appropriate secure or encrypted communication.
• Monitor authorization requests through completion and follow up when responses are not received within expected timeframes.
• Maintain organized records of submitted reports, authorization requests, referrals, and payer correspondence.

Authorization & Benefits Management

• Monitor the Funding Report and authorization expiration dates.
• Process authorization requests as new authorizations are received from CVRC, Kaiser, Physmetrics, HealthNet, Anthem, and other applicable payers.
• Maintain accurate authorization information in client profiles and applicable tracking systems.
• Monitor upcoming authorization expirations and initiate renewal processes in advance.
• Work at least one month ahead to identify upcoming authorization needs and help prevent lapses or interruptions in services.
• Review future Funding Reports to ensure required reports are scheduled, and authorization renewals are not missed.
• Pay particular attention to payers with specific report, referral, or authorization timelines, including Kaiser and Physmetrics.
• Follow up with insurance companies regarding pending authorization requests, outstanding requirements, and authorization status.
• Complete ongoing benefits verification and communicate relevant insurance information to the appropriate team members.
• Support families and internal teams through patient insurance changes, including obtaining and updating required insurance information and documentation.
• Identify potential authorization or coverage issues and communicate concerns to the appropriate leadership or team member.
• Maintain accurate and timely documentation of authorization and benefits related communication.

Doctor Referrals & Medical Documentation

• Review incoming doctor referrals for completeness and payer-specific requirements.
• Identify missing, expired, incomplete, or insufficient referrals.
• Follow up with physician offices to obtain updated referrals when required.
• Ensure referrals support the services being requested and contain all required information.
• Send therapist reports and required forms to PCP offices when necessary.
• Track outstanding physician referrals and follow up until the required documentation is received.
• Coordinate with families when additional physician documentation or updated referrals are needed.
• Review medical records requests to ensure a properly completed and signed ROI is provided.
• Verify that the patient's name and date of birth on medical record requests match the client's records before releasing information.
• Maintain accurate records of referral requests, physician communication, and received documentation.

Family & Therapist Communication

• Respond promptly and professionally to emails and requests from therapists, families, insurance companies, physician offices, regional centers, and other providers.
• Communicate with families regarding missing referrals, authorizations, reports, insurance information, and other documentation required to continue services.
• Follow up with families regarding outstanding documents or information needed to complete authorization or referral requirements.
• Communicate authorization status, referral requirements, and next steps to appropriate families and internal team members.
• Coordinate with therapists regarding upcoming reports, authorization needs, referral requirements, and documentation deadlines.
• Maintain professional and timely communication while protecting client confidentiality and following applicable privacy requirements.
• Document significant communication and follow-up activities in the appropriate client records or tracking systems.

Account Manager Support & Backup Coverage

• Provide backup coverage and administrative support for the Account Manager as needed.

Internal Coordination & Team Support

• Collaborate with clinical, intake, scheduling, billing, account management, and administrative teams to ensure authorization and referral requirements are communicated and addressed.
• Notify appropriate team members of upcoming authorization expirations, missing documentation, insurance changes, or potential service interruptions.
• Assist with identifying and resolving administrative barriers that may delay services.
• Maintain accurate and organized tracking systems, calendars, and client records.
• Participate in team meetings and provide updates regarding outstanding authorizations, referrals, benefits, and other assigned responsibilities.
• Assist with developing and maintaining standardized processes and procedures related to authorizations, referrals, benefits verification, and documentation.
• Cross-train with other administrative team members to support department coverage and continuity of operations.
• Perform other related duties and administrative responsibilities as assigned.

Qualifications

• Strong organizational and time-management skills with the ability to manage multiple deadlines and priorities.
• Excellent written and verbal communication skills.
• Strong attention to detail and accuracy when reviewing client, insurance, and medical documentation.
• Ability to communicate professionally and compassionately with families, therapists, medical providers, insurance representatives, and internal team members.
• Ability to independently track outstanding items and follow up consistently until resolution.
• Comfortable working with insurance companies, physician offices, regional centers, and other third-party providers.
• Ability to maintain confidentiality and handle sensitive client information appropriately.
• Strong computer and administrative skills, including the ability to learn and navigate multiple software systems and payer portals.
• Ability to work independently while also collaborating effectively with a multidisciplinary team.
• Ability to prioritize urgent and time-sensitive authorization and referral needs.
• Previous experience in healthcare administration, insurance authorizations, referrals, medical billing, behavioral health, speech therapy, or a related field is preferred.

Position Expectations

• Maintain accurate and timely documentation.
• Meet established authorization, referral, and reporting deadlines.
• Proactively identify upcoming needs rather than waiting until an authorization or referral has expired.
• Communicate potential barriers or delays promptly to the appropriate team members.
• Maintain professionalism, confidentiality, and a family-centered approach in all communications.
• Demonstrate flexibility and willingness to provide cross-coverage and support to the Account Manager and administrative team when needed.

Competencies

Authorization & Referral Management

Understands and independently manages authorizations and referral requirements across payers. Submits complete requests and follows them through resolution.

Accuracy & Attention to Detail

Accurately reviews reports, referrals, authorization dates, units, client demographics, signatures, forms, and payer requirements before submission. Identifies discrepancies before they create delays.

Insurance & Benefits Knowledge

Demonstrates working knowledge of insurance terminology, benefit verification, authorization requirements, referrals, coverage changes, and payer-specific processes. Knows when additional information or escalation is necessary.

Documentation & Record Management

Maintains complete, organized, timely, and accurate client records, authorization documentation, payer correspondence, tracking systems, and calendars. Significant communications and follow-up efforts are documented appropriately.

Problem Solving & Escalation

Recognizes potential barriers before they result in service interruptions. Investigates issues, identifies appropriate next steps, and escalates concerns to the correct person when resolution requires additional support.

Team Collaboration & Cross-Coverage

Works effectively with clinical, scheduling, intake, billing, account management, and administrative teams. Provides reliable Account Manager backup and contributes to continuity of operations.

Pay: $21.00 - $24.00 per hour

Benefits:

• 401(k) matching
• Dental insurance
• Employee assistance program
• Health insurance
• Paid time off
• Vision insurance

Work Location: In person