Authorization & Patient Financial Coordinator

Job Description

Authorization and Patient Financial Coordinator

Position Summary

The Integrated Patient Services Coordinator is responsible for managing all non-clinical administrative workflows related to durable medical equipment (DME), surgical prior authorizations, outside imaging prior authorizations, including associated documentation and patient financial communications. This role ensures timely insurance approvals, complete and audit-ready records, and accurate coordination of authorization-dependent services. The position functions as a desk-based revenue-cycle  and patient access specialist and does not include clinical duties.

Key Responsibilities

Durable Medical Equipment (DME) Authorization & Documentation

• Obtain and process prior authorizations for DME items including custom foot orthotics, AFOs, and other prescribed devices.
• Verify insurance benefits, coverage requirements, deductible status, and patient financial responsibility prior to ordering and dispensing.
• Conduct patient financial phone calls regarding insurance coverage, expected out-of-pocket responsibility, and financial consent processes.
• Provide all necessary financial documentation for clinical staff to appropriately bill and front office staff to apply payment
• Maintain complete documentation packets required for compliant billing and payer approval.
• Track authorization status, approval numbers, expiration dates, and resubmission requirements.
• Coordinate scheduling of scanning, fitting, and dispensing appointments in collaboration with front office staff.

Diabetic Shoe Program Administrative Coordination

• Manage all documentation and payer compliance requirements for the therapeutic diabetic shoe program.
• Obtain required certifying physician documentation and supporting medical records.
• Ensure all dispensing records, delivery confirmations, and coverage criteria are met prior to dispensing and billing.
• Conduct patient financial phone calls regarding insurance coverage, expected out-of-pocket responsibility, and financial consent processes.
• Provide all necessary financial documentation for clinical staff to appropriately bill and front office staff to apply payment
• Serve as the primary administrative point of contact for shoe-related payer inquiries and audits.

Surgical Prior Authorization & Preoperative Administrative Support

• Complete surgical prior authorization submissions and maintain payer-specific documentation requirements.
• Coordinate surgical scheduling logistics, including facility communication and tracking authorization timelines, approval numbers, expiration dates, and resubmission requirements.
• Coordinate any related DME requirements as in section 1.
• Obtain and organize required preoperative clearances and external documentation.
• Conduct patient financial phone calls regarding insurance coverage, expected out-of-pocket responsibility, and financial consent processes.
• Maintain complete surgical authorization and clearance records in the medical record.
• Coordinate scheduling of pre and postoperative appointments in collaboration with front office staff.
• Provide all necessary financial documentation for front office staff to appropriately apply payments
• Provide all necessary medical documentation for clinical staff to review during preoperative appointments

Imaging Prior Authorizations

• Process prior authorizations for imaging studies including MRI and CT scans.
• Submit clinical documentation supporting medical necessity and manage peer-to-peer coordination as needed.
• Track approvals and communicate authorization details to imaging facilities and scheduling staff.

Patient Financial Communication (Non-Clinical)

• Contact patients by phone to review insurance benefit determinations, expected costs, and financial responsibility for authorized services and DME.
• Ensure appropriate patient acknowledgment and financial consent documentation is completed prior to dispensing or scheduling.
• Escalate complex financial issues to practice leadership as needed.

Workflow Management & Quality Control

• Utilize standardized checklists and payer-specific protocols to reduce denials and documentation errors.
• Maintain an organized tracking system for all pending and approved authorizations.
• Monitor denial trends and assist in corrective documentation processes.
• Collaborate with billing (Central Office) and clinical teams to ensure accurate coding-support alignment and timely submission.

Scope of Role (Clarification)

This position is administrative and non-clinical.

The coordinator does not perform:

•  Patient rooming or clinical assisting
• Diabetic shoe measuring or fitting
• In-room preoperative visit support
• Direct clinical device application or education
• Clinical staff will perform all hands-on patient care and device fitting activities.

Qualifications

• Certified Professional Coder (CPC)
• Certified Medical Manager (CMM)
• Prior experience in DME authorization, surgical coordination, or specialty practice revenue-cycle workflows strongly preferred
• Strong knowledge of payer prior authorization processes, Medicare Advantage requirements, and documentation standards
• Excellent organizational skills and attention to detail

Key Performance Expectations

• Timely completion of DME, surgical, and imaging authorizations
• Reduction in authorization-related denials and documentation errors
• Maintenance of audit-ready documentation packets
• Clear, professional patient financial communication
• Effective coordination to prevent delays in care delivery