Pain Specialists of America ("PSA") is a Texas-based, multisite comprehensive pain management company that includes over 15 locations. We are seeking talented professionals who can support the business and help it achieve its strategic objectives.
The Workers’ Compensation Authorization & Referral Coordinator is responsible for managing all aspects of workers’ compensation pre-authorizations, referrals, and related documentation workflows for a large, multi-site pain management and ambulatory surgery center (ASC) organization. This role ensures timely and accurate authorization and referral processing, compliance with payer-specific guidelines, and alignment with revenue cycle operations to optimize reimbursement and minimize denials.
The ideal candidate will have strong knowledge of Texas WC processes, RCM operations, and payer workflows—supporting seamless coordination between clinical, scheduling, billing, and payer teams.
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
- 401k w/company match contribution
- Paid Time Off
- Short & Long-Term Disability
- HSA (w/company contribution) & FSA
- Life Insurance (company paid & voluntary options)
- 10 Paid Holidays for the Year 2025
- Employee Assistance Programs
