Authorization and Denial Coordinator

About Vitra Health

Vitra Health is a mission-driven healthcare organization committed to improving the quality of life for individuals and families across Massachusetts. Through innovative home- and community-based services, Vitra supports aging adults, people with disabilities, and individuals with complex care needs— supported by a Nurse, and Case Manager, Vitra ensures clients receive compassionate, personalized, and dignified care.

To help share our mission and expand our community impact, Vitra Health is seeking an Authorization and Denial Coordinator who is passionate about community engagement and helping people access the care and resources they deserve.

The Opportunity

The Authorization and Denial Coordinator is responsible for managing insurance authorizations, monitoring claim denials, and ensuring timely resolution of reimbursement issues. This role works closely with clinical, billing, and payer representatives to secure prior authorizations, reduce denials, and optimize revenue cycle performance. The ideal candidate is detail-oriented, organized, and experienced in healthcare insurance processes and claims management.

Key Responsibilities

Authorization Management

• Obtain and verify prior authorizations for services, treatments, and procedures.
• Review patient insurance eligibility and benefits to ensure coverage requirements are met.
• Submit authorization requests accurately and timely through payer portals, fax, or phone.
• Track authorization status and follow up with insurance companies as needed.
• Maintain accurate documentation of authorization approvals, denials, and expiration dates.
• Communicate authorization updates to clinical and scheduling teams.

Denial Management

• Review denied or rejected claims to identify root causes and trends.
• Research payer policies and determine appropriate corrective actions.
• Prepare and submit appeals with supporting documentation within payer deadlines.
• Work collaboratively with billing, coding, and clinical departments to resolve claim issues.
• Monitor denial reports and maintain denial logs for tracking and reporting purposes.
• Escalate unresolved or recurring denial issues to leadership.

Revenue Cycle Support

• Assist with claim edits, payment posting discrepancies, and reimbursement follow-up.
• Ensure compliance with payer guidelines, CMS regulations, and company policies.
• Support process improvement initiatives aimed at reducing denials and increasing collections.
• Maintain confidentiality of patient and financial information in accordance with HIPAA regulations.
• Participate in audits, training, and departmental meetings as required.
• Fosters a culture of customer service and commitment to quality care
• Serves as a brand ambassador for Vitra reflecting our vision, mission, and values
• Shows a genuine interest and compassion for the communities we serve and commitment to the diversity of our clients and team members
• Mentor and supports team members
• Complete other tasks as assigned

What we are looking for:

• High school diploma or equivalent required; Associate's degree preferred.
• Minimum of 2 years of experience in healthcare revenue cycle, medical billing, authorizations, or denial management.
• Knowledge of insurance verification, prior authorizations, claims processing, and appeals.
• Familiarity with Medicare, Medicaid, and commercial insurance plans.
• Experience using EMR/EHR systems and billing software.
• Strong understanding of medical terminology, CPT, ICD-10, and HCPCS coding concepts preferred.
• Excellent organizational, communication, and problem-solving skills.
• Proficiency in Microsoft Office, including Excel and Outlook.
• Ability to manage multiple priorities in a fast-paced environment.
• Strong attention to detail and accuracy.
• Effective follow-up and payer negotiation skills.
• Analytical mindset with the ability to identify denial trends and process improvements.

Work Environment and Physical Requirements

• Office-based work in a clean well-lit environment with fluctuating temperatures near others.
• Client-facing field staff and community liaisons require frequent travel to client homes or community settings; ability to drive safely; work in client homes may involve varying temperatures, odors, allergens, pets, and other environmental factors.
• Requires substantial periods of repetitive work utilizing a computer, monitor, keyboard, and mouse.
• Requires lifting and carrying equipment and supplies weighing up to 35 pounds; requires pushing and pulling equipment and supplies weighing up to 35 pounds; requires walking and standing; requires frequent sitting more than 75% of the workday; requires the ability to negotiate stairs; requires visual acuity and manual dexterity to operate equipment.

Perks and Benefits:

• Employer sponsored health Insurance with a generous employer match.
• Dental and Vision Benefits.
• Supplemental Benefits
  • Life, Accident, Critical Illness and Disability Insurance.
• 401K with a 5% company match.
• Accrued Paid-Time-Off.
• Ten company paid holidays.
• Wellness Benefits.
• Tuition Reimbursement.
• Supportive team structure and company culture with a focus on work/life balance.

Vitra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, pregnancy, sexual orientation, gender identity, national origin, age, protected veteran status, or disability status.