RCM Coordinator - Insurance Verification

* Verify patient eligibility and insurance benefits through payer portals, clearinghouses, and direct payer communication.* Conduct ongoing eligibility checks for Medicaid, Medicare, Managed Care Organizations (MCOs), and commercial insurance.* Ensure coverage is properly linked in the system for all service lines, including Primary Care, Behavioral Health, IDD, ECI, ABA Therapy, and LIDDA.* Monitor for lapses in eligibility and proactively communicate with clients and program staff to minimize service interruptions.* Verify insurance coverage and benefits prior to client appointments using payer portals, clearinghouses, and direct payer contact.* Obtain and track pre-authorization numbers, service approvals, and re-authorization renewals when applicable.* Confirm service-level coverage, including visit limits, co-pays, deductibles, and prior authorization requirements.* Assist families with Medicaid applications, renewals, and eligibility-related documentation as needed.* Document eligibility status, coverage changes, and updates in the electronic health record (EHR) or billing system.* Coordinate with RCM Claims staff to prevent claim denials related to coverage.* Prepare reports on eligibility status, payer trends, and at-risk clients for management review.* Performs other duties as assigned.* Conducts job responsibilities in accordance with the ethical standards of conduct, state contract, appropriate professional standards and applicable state/federal laws.* Analytical skills, professional acumen, business ethics, thorough understanding of continuous improvement processes, problem solving, respect for confidentiality, and excellent communication skills.* Knowledge of Medicaid, Medicare, MCO, and commercial eligibility requirements.* Understanding of eligibility processes specific to HCBS waivers, LIDDA programs, ECI, and behavioral health services.* Ability to interpret coverage limits, exclusions, and tiered benefits for multiple service types.* Knowledge of insurance benefit structures, prior authorization processes, and payer-specific verification rules.* Strong organizational and analytical skills.* Excellent verbal and written communication skills.* Ability to work independently and manage multiple tasks with attention to detail.* Professionalism and respect for confidentiality when handling sensitive client and payer information.* **Preferred:** Associate’s degree in healthcare administration, business, or related field; prior experience in insurance verification, authorizations, or benefits coordination within healthcare or behavioral health settings.* A bachelor's degree will be accepted in place of experience.* Basic math skills required.* Ability to work with reports and numbers & Ability to calculate moderately complex figures and amounts to accurately report activities and budgets.* Ability to apply common sense understanding to carry out simple one or two-step instructions.* Strong reasoning and problem-solving skills with the ability to make informed decisions in a dynamic and client-centered environment.* Use computer, printer, and software programs necessary to the position (i.e., Word, Excel, Outlook, and PowerPoint).* Ability to utilize Internet for resources.* Medical/Dental/Vision* Paid Time Off* Paid Holidays* Employee Assistance Program* Retirement Plan, including employer matching* Health Savings Account, including employer matching* Professional Development allowance up to $2000 per year* Bilingual Stipend – 6% of the base salary* Many other benefits #J-18808-Ljbffr