Authorization Coordinator - 138404

The Insurance Authorization Coordinator and Patient Biller - Interventional Psychiatry is responsible for the full range of third party and patient authorization and billing duties. The Authorization Coordinator will work closely with our multidisciplinary team of psychiatric providers, nurses, and TMS techs to oversee insurance authorization for patients with treatment-resistant mental health disorders for our three main outpatient procedural services; Transcranial Magnetic Stimulation, Esketamine/Ketamine and Electroconvulsive Therapy. Extensive knowledge of medical insurance and State and Federal rules and regulations related to billing Insurance Claims. Extensive knowledge in Insurance claims appeals, and range of knowledge in ICD-9, CPT, HCPCS, coding principles.

Knowledge in self pay collections and mandated charity laws. Knowledge of medical/surgical terminology. Knowledge of accounting and cash handling principles and various billing documents and claim forms. Responsible to work system generated claims, edits, attaches records, operative reports and all system reports. Responds to billing inquiries from patients, insurance companies and departments. Identifies and resolves issues regarding account adjustments, re-billing insurance, and/or collecting from patients as appropriate. The Medi-Cali Patient Biller is responsible for the full range of Medi-Cal patient billing, collection and denial duties. This includes FFS Medi-Cal, Medi-Cal Managed Care, CMS, GHPP, CCS, Ryan White, and Sheriff billing and collections.

• Minimum five (5) years relevant experience preferred in a hospital setting or medical insurance.

• Knowledge of behavioral health insurance carve-outs.

• State and Federal rules and regulations related to billing Insurance Claims.

• Demonstrated knowledge in self-pay collections.

• Thorough knowledge of UB04 and revenue codes as it pertains to billing.

• Extensive knowledge in Insurance claims appeals, and range of knowledge in ICD9, CPT, HCPCS coding principles.

• Knowledge of Hospital payer contracts and reimbursement methodologies including but not limited to per diem, fee schedule, case rate and DRG's.

• EDX, Siemens, CPT & ICD9 Medical Coding Knowledge, EPIC System and MSOutlook.
• Previous hospital billing experience.
• Experience with authorizations for specialty visits and procedures.

• Must be able to work various hours and locations based on business needs.
• Employment is subject to a criminal background check and pre-employment physical.