Administration-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.

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.