Pain Specialists of America
Referral & Authorization Coordinator - Workers Compensation
Pain Specialists of America, Austin, Texas, us, 78716
Pain Specialists of America ("PSA") is a Texas–based, multisite comprehensive pain management company with over 15 locations. We are seeking a Workers’ Compensation Authorization & Referral Coordinator to manage all aspects of workers’ compensation pre‑authorizations, referrals, and related documentation workflows for our multi‑site pain management and ambulatory surgery center organization.
Authorization & Referral Management
Obtain, track, and manage all pre‑authorizations for WC and related injury claims across clinic and ASC settings.
Review medical necessity documentation and provider notes to ensure completeness before submission.
Coordinate referrals between internal providers, specialists, and ancillary service partners.
Validate claim identifiers (e.g., DOI, claim number, adjuster info, employer details) before scheduling.
Monitor and follow up on pending authorizations daily to prevent scheduling delays.
Maintain comprehensive logs of authorization approvals, denials, and expirations in PM/EHR systems (HST, eCW, or equivalent).
Ensure adherence to state‑specific WC rules (DWC, CMS crossover, and payer guidelines).
RCM & Operational Collaboration
Partner with RCM leadership to ensure WC workflows align with billing, payment posting, and appeals processes.
Support verification and coordination of benefits, ensuring correct payer setup and documentation for first reports of injury.
Communicate authorization status to billing and collections teams for timely claim submission.
Identify trends in WC denials, delays, or payer issues and escalate to RCM management for resolution.
Assist in refining SOPs and workflows to improve efficiency and compliance.
Compliance & Documentation
Ensure all documentation complies with payer, DWC, and HIPAA requirements.
Maintain audit‑ready authorization records and support internal/external reviews.
Participate in ongoing payer training and updates regarding WC processes and system enhancements.
Benefits
Medical, Dental, Vision Insurance
401(k) with company match contribution
Paid Time Off
Short & Long‑Term Disability
HSA (with company contribution) & FSA
Life Insurance (company paid & voluntary options)
10 Paid Holidays for the Year 2025
Employee Assistance Programs
Requirements
Education: High school diploma or equivalent required; Associate’s or Bachelor’s degree in Healthcare Administration or related field preferred.
Experience:
3+ years of experience in workers’ compensation authorization or case management, preferably in pain management, orthopaedic, or surgical specialty.
2+ years of experience in RCM operations, including familiarity with billing workflows, claims, and denials.
Hands‑on experience with HST, eClinicalWorks (eCW), or similar PM/EHR systems.
Knowledge/Skills:
Strong understanding of Texas WC regulations, DWC processes, and payer authorization portals.
Excellent attention to detail, organizational, and time‑management skills.
Effective communicator able to work across clinical, billing, and administrative teams.
Proficient in Microsoft Excel, Teams, and PM/EHR authorization dashboards.
Performance Metrics
Average turnaround time on authorization requests (target = 48 hours).
WC denial rate for lack of authorization (target).
Referral coordination completion rate.
Accuracy and timeliness of documentation updates in PM/EHR system.
Provider and payer satisfaction feedback.
Core Competencies
Accountability & Ownership
Cross‑Functional Collaboration
Regulatory Compliance
Problem‑Solving & Process Improvement
Communication & Customer Service
Seniority level Mid‑Senior level
Employment type Full‑time
Job function Health Care Provider
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Authorization & Referral Management
Obtain, track, and manage all pre‑authorizations for WC and related injury claims across clinic and ASC settings.
Review medical necessity documentation and provider notes to ensure completeness before submission.
Coordinate referrals between internal providers, specialists, and ancillary service partners.
Validate claim identifiers (e.g., DOI, claim number, adjuster info, employer details) before scheduling.
Monitor and follow up on pending authorizations daily to prevent scheduling delays.
Maintain comprehensive logs of authorization approvals, denials, and expirations in PM/EHR systems (HST, eCW, or equivalent).
Ensure adherence to state‑specific WC rules (DWC, CMS crossover, and payer guidelines).
RCM & Operational Collaboration
Partner with RCM leadership to ensure WC workflows align with billing, payment posting, and appeals processes.
Support verification and coordination of benefits, ensuring correct payer setup and documentation for first reports of injury.
Communicate authorization status to billing and collections teams for timely claim submission.
Identify trends in WC denials, delays, or payer issues and escalate to RCM management for resolution.
Assist in refining SOPs and workflows to improve efficiency and compliance.
Compliance & Documentation
Ensure all documentation complies with payer, DWC, and HIPAA requirements.
Maintain audit‑ready authorization records and support internal/external reviews.
Participate in ongoing payer training and updates regarding WC processes and system enhancements.
Benefits
Medical, Dental, Vision Insurance
401(k) with company match contribution
Paid Time Off
Short & Long‑Term Disability
HSA (with company contribution) & FSA
Life Insurance (company paid & voluntary options)
10 Paid Holidays for the Year 2025
Employee Assistance Programs
Requirements
Education: High school diploma or equivalent required; Associate’s or Bachelor’s degree in Healthcare Administration or related field preferred.
Experience:
3+ years of experience in workers’ compensation authorization or case management, preferably in pain management, orthopaedic, or surgical specialty.
2+ years of experience in RCM operations, including familiarity with billing workflows, claims, and denials.
Hands‑on experience with HST, eClinicalWorks (eCW), or similar PM/EHR systems.
Knowledge/Skills:
Strong understanding of Texas WC regulations, DWC processes, and payer authorization portals.
Excellent attention to detail, organizational, and time‑management skills.
Effective communicator able to work across clinical, billing, and administrative teams.
Proficient in Microsoft Excel, Teams, and PM/EHR authorization dashboards.
Performance Metrics
Average turnaround time on authorization requests (target = 48 hours).
WC denial rate for lack of authorization (target).
Referral coordination completion rate.
Accuracy and timeliness of documentation updates in PM/EHR system.
Provider and payer satisfaction feedback.
Core Competencies
Accountability & Ownership
Cross‑Functional Collaboration
Regulatory Compliance
Problem‑Solving & Process Improvement
Communication & Customer Service
Seniority level Mid‑Senior level
Employment type Full‑time
Job function Health Care Provider
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