Position Summary

The Unit Coordinator is responsible for managing front-end insurance authorization processes, facilitating concurrent reviews, and supporting state-specific insurance billing requirements. This role ensures coordinating timely compliance reporting and collaborates closely with leadership and the compliance department to maintain adherence to regulatory standards. The position is integral to optimizing reimbursement, minimizing denials, and ensuring operational and regulatory alignment.

Qualifications

Education

• High school diploma or equivalent required 
• Associate’s or Bachelor’s degree in healthcare administration, business, or related field preferred 

Experience

• Minimum of 2–3 years of experience in insurance authorization, utilization review, or healthcare billing 
• Experience with state-funded insurance programs and behavioral health settings strongly preferred 
• Demonstrated experience in compliance-related processes within a healthcare environment 

Skills & Competencies

• Strong knowledge of insurance authorization processes, medical necessity criteria, and payer requirements 
• Working knowledge of state insurance billing regulations and compliance standards 
• High level of attention to detail and organizational effectiveness 
• Ability to manage multiple deadlines and prioritize in a fast-paced environment 
• Effective communication and collaboration skills across interdisciplinary teams 
• Proficiency in electronic health records (EHR) and billing systems 

Key Responsibilities

Insurance Pre-Certification & Authorization

• Initiate and secure insurance pre-certifications for all admissions in accordance with payer requirements. 
• Verify eligibility, benefits, and coverage limitations prior to or at the time of admission. 
• Maintain accurate tracking of authorization status, approved days, and required follow-up actions. 
• Communicate proactively with payers to prevent authorization gaps and mitigate risk of non-reimbursable days. 

Concurrent Review & Continued Stay Management

• Conduct and coordinate concurrent reviews with insurance providers to obtain continued stay approvals. 
• Collaborate with the treatment team to ensure documentation supports medical necessity. 
• Submit clinical updates to payers within required timeframes to support ongoing authorization. 
• Escalate potential denials or insufficient documentation concerns to leadership and appropriate stakeholders. 

State Insurance Billing Processes

• Implement and facilitate state-specific insurance billing processes in alignment with regulatory requirements. 
• Ensure accurate and timely submission of billing-related information to support claims processing. 
• Monitor billing workflows to ensure compliance with payer and state guidelines. 
• Partner with the business office to resolve billing discrepancies and support revenue cycle integrity. 

Compliance Coordination & Reporting

• Coordinate timely compliance reviews related to authorizations, billing, and payer requirements. 
• Prepare and submit required reports to the compliance department, ensuring accuracy and completeness. 
• Identify trends, gaps, or risks related to compliance and escalate as appropriate. 
• Maintain thorough documentation to support internal audits and external regulatory reviews. 

Staff Training & Compliance Collaboration 

• Work collaboratively with the compliance department to identify and communicate staff training needs 
• Ensure training requirements are disseminated to appropriate staff in a timely manner. 
• Maintain and update training trackers and documentation to ensure compliance with organizational standards
• Support leadership in reinforcing compliance expectations and accountability. 

Collaboration & Leadership Support

• Work collaboratively with facility leadership to ensure compliance-related objectives and performance targets are achieved. 
• Serve as a liaison between admissions, utilization review, clinical teams, billing, and compliance. 
• Participate in multidisciplinary meetings to provide updates on authorization, billing, and compliance metrics. 
• Support process improvement initiatives aimed at enhancing efficiency, compliance, and reimbursement outcomes. 

Operational Coordination- Meal Count Oversight

Patient Assistance