CCM Billing & Insurance Referral Coordinator

At Eventus WholeHealth, we are transforming healthcare delivery within skilled nursing and assisted living facilities through an integrated, evidence based model. Since 2014, our mission has been to improve patient outcomes by providing comprehensive, whole person care supported by strong interdisciplinary collaboration. We partner closely with facilities, enhance clinical workflows, and support teams in delivering exceptional care to residents.
Join a growing organization where your work directly strengthens care quality, clinician efficiency, and patient experience.

Position Summary
The CCM Billing & Insurance Referral Coordinator is responsible for reviewing, completing, and maintaining RFI reports related to Chronic Care Management (CCM) billing. This role also manages insurance referral and authorization requests through designated payer portals, helping ensure services are properly documented, submitted on time, and aligned with payer and organizational requirements

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  1.Review RFI reports for CCM billing accuracy, completeness, and supporting documentation. 

  
  


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  2.Research and resolve missing, inconsistent, or incomplete patient, provider, diagnosis, service, time-tracking, and billing information. 

  
  


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  3.Complete and update RFI reports within established timelines and communicate unresolved issues to appropriate stakeholders. 

  
  


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  4.Ensure CCM billing documentation complies with internal policies, payer requirements, and regulatory guidelines. 

  
  


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  5.Submit, track, and document insurance referrals and prior authorization requests through designated payer portals.

  
  


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  6.Monitor referral and authorization statuses and follow up on pending, denied, expired, or incomplete requests. 

  
  


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  7.Maintain accurate records of approvals, authorization numbers, referral details, supporting documentation, and effective dates. 

  
  


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  8.Coordinate with providers, clinical teams, billing staff, and insurance representatives to resolve referral and billing issues. 

  
  


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  9.Escalate denials, payer discrepancies, compliance concerns, and unresolved issues to management as appropriate. 

  
  


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  10.Prepare reports and status updates regarding RFI completion, referral activity, authorization approvals, and outstanding follow-up items. Other related duties as assigned.

  
  

Skills and Qualification

• 2  years' experience in healthcare setting


• Computer skills and proficiency


• Effective verbal and written communication skills


• Highly organized with confidential client material, appointment tracking and caseload


• Strong customer service skills, knowledge of geriatric population and patient navigation


• Ability to work independently, deliver to deadlines, and effectively handle multiple priorities 


• Ability to solve problems with minimal direction


• Great attention to detail and accuracy


• Interest in working with geriatric clients


• Experience in medical billing, revenue cycle, referrals, prior authorizations, care coordination, or healthcare administration preffered


• Familiarity with CCM billing workflows, CPT coding concepts, insurance verification, and payer portal navigation

PHYSICAL REQUIREMENTS:   The physical demands described here are representative of those that must be met by an employee to successfully perform the job.

• While performing the duties of this job, the employee is regularly required to communicate with others, including the ability to express oneself and exchange information in what, at times, could be a stressful or high-pressure environment. 


• The employee frequently is required to move about the office to access files, use office equipment, and to interact with others.   The person must be able to sit or remain in a stationary position for extended periods of time to be able to work, communicate on the phone, utilize the computer, and interact with others.  The employee is occasionally required to stand or otherwise be able to access files, equipment, and other items in high places. 


• Employee must be able to constantly operate computers, phones, and other office equipment. 


• Employee must be able to bend, stoop, kneel, crouch, or crawl. 

WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the job.

• The noise level in the work environment is usually low to moderate. 


• Due to the collaborative nature of the business and the need to service customers, the employee must be able to interact effectively with others in an office environment, manage conflict, and handle stressful situations and deadlines. 

• Requires desk work in office environment.

Ability to work flexible hours as needed to meet deadlines

Consistent with applicable federal and state laws, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job.

This description reflects the Company’s assessment of the essential functions of the job but does not proscribe or restrict other tasks that may be assigned from time to time.  Duties, responsibilities, and activities may change at any time with or without notice.