Referral & Authorization Coordinator - Workers Compensation

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.

• 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).

• 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.

• 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.

• 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

• 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, eClinical
    
    Works (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.

• 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.

• Accountability & Ownership
• Cross‑Functional Collaboration
• Regulatory Compliance
• Problem‑Solving & Process Improvement
• Communication & Customer Service

Mid‑Senior level

Full‑time

Health Care Provider