Insurance Coordinator

Description

Primary Purpose

The insurance Coordinator is responsible for managing all insurance-related processes for behavioral health services, including eligibility verification, prior authorizations, benefits coordination, claims support, and payer communications. This role ensures accurate insurance processing, compliance with payer requirements, and a smooth financial experience for clients receiving in-office and telehealth behavioral health services.

The ideal candidate has strong behavioral health insurance experience, understands mental health CPT/diagnosis codes, and is highly detail-oriented, organized, and client-centered.

Education and Experience

Minimum 3-4 years of insurance coordination experience, preferably in behavioral or mental health. Strong knowledge of behavioral health insurance benefits, authorizations, and payer rules. Familiarity with CPT, ICD-10, and behavioral health billing workflows. Experience working with Medicaid, Medicare, and commercial payers. Proficiency with EHR and billing systems. Excellent organizational, communication, and problem-solving skills. High attention to detail and ability to manage multiple cases simultaneously. Preferred Experience with telehealth behavioral health billing and authorizations. Knowledge of state-specific behavioral health payer requirements. Experience in a nonprofit or community mental health setting. Bilingual (preferred but not required)

Minimum Qualifications

• Provide proof of current, valid Oregon Driver's License (or if out-of-state will obtain Oregon license within 30 days), comprehensive automobile insurance (if applicable) and a safe driving record (minimum of 3 yrs.) to use company or personal vehicle for required duties.
• Successfully pass a Criminal Background Check and Medicaid Fraud Check.

Essential Duties, Responsibilities and Core Competencies

Insurance Verification & Benefits

• Verify insurance eligibility and behavioral health benefits prior to services
• Confirm coverage for in-office and telehealth behavioral health services
• Review co-pays, deductibles, coinsurance, visit limits, and authorization requirements
• Accurately document benefits and financial responsibility in the EHR/billing system

Authorization & Utilization Management

• Obtain and manage prior authorizations for behavioral health services
• Track authorization start/end dates, approved units, and reauthorization timelines
• Coordinate with clinicians to obtain required clinical documentation
• Communicate authorization status to internal teams and clients as appropriate

Claims & Payer Communication

• Serve as a liaison between the organization and insurance companies
• Resolve insurance issues related to coverage, denials, or payment discrepancies
• Follow up with payers regarding claims status and required documentation
• Assist billing team with insurance-related claim correction and appeals

Client & Team Support

• Provide clear, compassionate explanation of insurance benefits to clients
• Support clinicians and scheduling staff with insurance-related questions
• Maintain confidentiality and compliance with HIPAA and behavioral health regulations
• Collaborate closely with billing, finance, and clinical teams

Compliance & Documentation

• Ensure insurance processes comply with payer contracts and state/federal regulations
• Maintain accurate, timely documentation of insurance activity
• Assist with audits, reporting, and quality assurance related to insurance processes

Safety and Work Environment

• Abide by ethical codes, mission, values, and professional standards, including confidentiality.
• Actively utilize, reference, and follow agency policies, procedures, and guidelines.
• Present a positive attitude, professional demeanor and demonstrated respect with youth and young adults, families, staff, visitors, and community partners.
• Perform all work tasks in a proper and safe manner per established policies, procedures, and guidelines to prevent unnecessary injury, time loss and agency expense.
• Comply with all federal, state and agency health and safety reporting requirements.

Other Duties

• Perform other related work as assigned.
• Attend trainings and meetings as assigned. May be appointed to committees.

Attendance

• Maintain prompt and regular attendance in accordance with company policy.
• Ability to be flexible and adjust schedule as necessary to fit program needs.

Physical Demands: The physical demands described here are representative of those that must be met by the staff person to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the staff person is regularly required to use hands to type, handle, reach with hands and arms, talk or hear. The staff person frequently is required to stand and walk. The staff person is occasionally required to sit, stoop, kneel, crouch or crawl. The staff person must frequently lift and or move up to 10 pounds and occasionally lift and/or move up to 45 pounds. Specific vision abilities required for this job include close vision, distance vision, and depth perception and operating a motor vehicle.

Working Conditions: The working conditions described here are representative of those that must be met by the staff person to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the staff person is frequently exposed to loud noises, outside weather conditions such as heat, cold and humidity. The staff person is occasionally exposed to chemical solutions and body fluids.


Hazardous Conditions: Risk of verbal and physical threats and harm from clients. Possible exposure to air and Bloodborne Pathogens.

Equipment Used: May include general office equipment, such as computer, telephone, agency or personal vehicle, general cleaning supplies, and kitchen utensils/supplies.

Travel: Travel is expected for required trainings.

Other Responsibilities: This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Staff's Attestation constitutes staff's understanding of the requirements, essential functions, and duties of the position.

Requirements

In order to be considered for a position with Kairos, applicants must meet and agree to the following requirements:

• Meet all Education and/or Experience Requirements listed for the specific position.
• Provide references upon request.
• Request official transcripts upon offer of employment.
• Provide proof of current, valid Oregon Driver's License (or if out-of-state will obtain Oregon license within 30 days), comprehensive automobile insurance (if applicable) and a safe driving record (minimum of 3 yrs.) to use company or personal vehicle for required duties.
• Successfully pass a Criminal Background Check and Medicaid Fraud Check.
• Obtain and maintain current CPI Verbal De-Escalation Certification during employment.
• Obtain and maintain current First Aid and Cardiopulmonary Resuscitation (CPR) certification during employment.
• Obtain a Food Handler's Card once employed.