Reimbursement Operations Coordinator - Prior Authorizations

Koya is always looking for curious and passionate individuals who want to join a fast-paced team for a career in transforming venous and lymphatic care through innovative people-centric technologies that improve lives and empower self-care. Koya values integrity, humility, hard work, camaraderie, and fun. We offer a base + bonus compensation package, and a competitive benefits program.

About Koya Medical

Koya Medical, a privately held company founded in 2018, is a transformative healthcare company developing breakthrough treatments for venous diseases and lymphedema to enable joint contractions, patient mobility, and personalized care that is unavailable with traditional compression therapy. Koya is always looking for curious and passionate individuals who want to join a fast-paced team for a career in transforming venous and lymphatic care through innovative people-centric technologies that improve lives and empower self-care. Koya values integrity, humility, hard-work, camaraderie, and fun. We offer a base + bonus compensation package, and a competitive benefits program.

Description

Job Summary

The Reimbursement Operations Coordinator plays a vital role in supporting the daily operations of the Prior Authorization team. This position is responsible for ensuring timely and accurate communication with payers and facilitating efficient follow-up on prior authorization requests.

Key responsibilities include conducting high-volume outbound calls to insurance companies to check the status of authorization submissions, retrieving determinations from payer portals, and verifying the accuracy of approval details. The coordinator will also create tasks for reauthorization requests, support case processing, and maintain organized, complete documentation.

This role works closely with Prior Authorization Specialists to ensure seamless workflow across the department and contributes to ongoing process improvements that enhance efficiency and accuracy. We are seeking a highly organized individual who can work independently in a remote environment and demonstrate excellent communication skills.

This is a full-time, exempt, remote position.

Essential Duties And Responsibilities

The essential functions include, but are not limited to the following:

• Communicate with payers to follow up on statuses of prior authorizations
• Communicate with the team members about authorization statuses
• Submit additional information to payers if needed for processing of authorizations
• Process approvals and denials accurately in salesforce
• Communicate with clinician offices to obtain medical records, required documentation and signatures that are needed to assist with the authorization process
• Assist the department with dispersing correspondence
• Maintain a high level of accuracy while meeting productivity and quality requirements
• Support other departments to ensure accurate processing of patient orders and payer approvals and denials
• Identify trends for process improvement and communicate to leadership
• Assist in the development of internal processes and best practices for the reimbursement operations department
• Benefit and authorization process investigation
• Follow all compliance and HIPAA requirements
• Other duties as assigned
  
  

Minimum Qualifications

Education, Experience and Training

• High school diploma or equivalent, Associate’s or Bachelor’s degree a plus
• Previous experience in the medical device industry, healthcare reimbursement or related field
  
  

Knowledge, Skills And Abilities

• Excellent written and verbal communication skills
• Excellent problem solving and analytical skills
• Ability to produce grammatically accurate authorization, appeal and patient correspondence
• High attention to detail
• Ability to work under pressure and deliver complete, accurate, and timely results
• Proven ability to work independently, multitask, prioritize and meet required deadlines
• Ability to be persuasive and credible with payers
• Working knowledge and expertise of insurance processes
• Technology savvy and able to navigate payer portal systems
• Ability to work independently and in collaboration with a team
• Able to provide clear and concise communication to payers, field reps, clinicians, peers and management via phone, email, video conference and/or in person
  
  

Core Competencies

• Communication & cultural competence
• Initiative & critical thinking
• Flexibility & adaptability
• Planning & organization
• Teamwork & collaboration
  
  

Tools and Technology

Google suite, Adobe, Salesforce CRM

Physical Functions And Work Environment

The physical functions described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the functions.

While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands or fingers; handle or feel objects, tools, or controls. The employee is occasionally required to stand; walk; sit; and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this position include close vision, distance vision, and the ability to adjust focus. The noise level in the work environment is usually low to moderate.

Note

This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by any Koya manager authorized to provide instruction or assign work. Duties, responsibilities, and activities may change at any time with or without notice.

All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills, aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise, other than an “at will” relationship.

Koya Medical, Inc. is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.

Salary

$53,500 - $56,000 per year