Insurance Authorization & Clinical Support Coordinator

Description:

CRCC is looking for an Insurance Authorization & Clinical Support Coordinator. This position will be full-time working Monday through Friday between the hours of 6:30am-5:30pm. This person will work at our Administrative Center. This individual will also work onsite at both our centers; NW Center (88th and Blondo) and our SW Center (138th and Q) for training and as needed.

Starting pay is $25-$30 an hour, based on experience. Our full-time staff benefits include robust holiday pay that includes pay for the work days from Christmas to New Years!

Position Expectations:

The Insurance Authorization & Clinical Support Coordinator is responsible for managing all insurance pre-authorizations, re-authorizations, and related documentation processes for pediatric therapy services (PT, OT, SLP). This role ensures timely approval of services, minimizes interruptions in care, reduces denials, and supports therapists in maintaining full clinical productivity.

This position works closely with therapists, billing staff, families, and insurance providers to ensure accurate and compliant authorization processes across a diverse pediatric population, including medically fragile and complex cases. This position serves as the operational bridge between clinical documentation and revenue cycle processes. The role does not perform claim submission but ensures all required documentation and authorization elements are accurate and complete prior to billing handoff.

Benefits

CRCC offers an Excellent Benefit Package for full-time employees.

• Health insurance
• Dental insurance
• Vision insurance
• CRCC-paid short & long term disability and life insurance
• PTO
• Holiday pay Paid Holiday Pay for full-time employees between Christmas and New Years!
• 401k with match

Below are examples of the impact YOU can make!"CRCC has been nothing but a blessing to my son. He has grown and learned so much during his time with CRCC. ""Our stressful situations were all care related, having the daily health services have provided a place for our child to attend with nursing services.""Knowing my child is somewhere where they are safe, understood and able to grow has helped me be more productive during the day.""CRCC provides a safe, welcoming place for us to bring our daughter where everyone knows her name, appreciates her, and cares for her as if they were family."

CRCC Mission and Values CRCC is a local non-profit organization dedicated to providing comprehensive services to children with special needs to help them reach their highest potential. CRCC values Quality Care for Children, Family Involvement, and Staff Excellence. CRCCs work environment is energetic and team-oriented.

Essential Responsibilities

Insurance Authorization Management

• Verify insurance coverage annually and as needed (primary and secondary)
• Submit initial authorizations and re-authorizations for PT, OT, and SLP services
• Track authorization expiration dates and proactively initiate renewals
• Manage authorization tasks within the EHR to prevent coverage lapses
• Monitor approved visit counts and ensure services remain within authorized parameters
• Maintain a real-time authorization tracking system (including visit counts, auth dates, and re-evaluation timelines)
• Upload and maintain all authorization-related documentation within the EHR (approvals, denials, appeals, verification records)
• Follow up on medical necessity reviews and authorization determinations
• Track coordination-of-benefits requirements for primary and secondary payers.
• Escalate recurring denial patterns, payer inconsistencies, or complex authorization disputes to the Revenue Cycle Manager for system-level review

Documentation Coordination

• Intake process to include but not limited to, obtaining consents, MD orders, annual insurance cards, and building client cases in EHR
• Collect required evaluations, plans of care, progress notes, and supporting documentation
• Communicate with therapists regarding documentation updates needed for authorization submission
• Ensure timely submission of medical necessity documentation to payers
• Obtain primary payer EOB denials when needed to support secondary billing processes
• Assist with Letters of Medical Necessity and DME-related documentation coordination (including Hanger clinic follow-up and approval/denial tracking as applicable)

Denials & Appeals Management

• Review authorization denials for completeness and required follow-up
• Coordinate with therapists to compile documentation for reconsideration
• Prepare and submit authorization reconsiderations in accordance with payer guidelines
• Track appeal outcomes and communicate status to relevant parties

Communication

• Serve as liaison between families and insurance carriers regarding authorization status
• Communicate authorization limits and visit availability to therapists
• Provide timely updates to therapy leadership regarding authorization issues impacting scheduling or care continuity

Compliance & Quality Control

• Maintain HIPAA compliance in all payer and family communications
• Adhere to established payer authorization requirements and internal policies
• Ensure documentation submitted for authorization supports medical necessity standards
• Maintain credentialing compliance and credentialing new hires as needed.

Requirements:

Preferred Qualifications

• Experience in pediatric therapy clinic, hospital, or medical office
• Strong knowledge of:
• Nebraska Medicaid
• Commercial insurance authorization processes
• Tricare preferred
• Experience with EMR systems
• High attention to detail
• Ability to manage multiple payers simultaneously
• Strong organizational and tracking skills
• Maintains confidentiality with all information regarding our clients and their families.
• Ability to give superior customer service and effectively answer questions.
• Ability to prioritize, multi-task, and know when to escalate issues.
• Ability to meet organizations conditions of employment regarding health status and clearance with the Nebraska Child Abuse/Neglect Central Registry and/or Adult Abuse/Neglect Registry and the Nebraska State Patrol.

Preferred Education

• Associates degree or higher in healthcare administration or related field (not required if experienced)

Compensation details: 25-30 Hourly Wage

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