Authorization Coordinator

Job Summary

The Authorization Coordinator handles timely and accurate processes associated with pre-certification, obtaining and certifying authorizations, assisting with appeals of authorizations, collaborating with the referral coordinator to ensure all approvals are obtained, and ensuring appropriate documentation is entered into the standard billing system.

Responsibilities

• Review and completion of prior authorizations to ensure timeliness of appointments, testing, procedures, and claims filing.
• Obtain clinical information (including but not limited to medical history, diagnosis, and any relevant lab reports) necessary to complete the Prior Authorization to include insurance requirements.
• Follow the criteria for all services requiring prior authorizations and submit requests in a timely manner.
• Ensure appropriate documentation is entered into the standard billing system.
• Tracks status of prior authorizations via payor authorization portal.
• Reviews denied claims for clinical accuracy, corrects errors for claims resubmission.
• Clearly support patient experience through patient-centered communications proving excellent customer service skills.
• Communicate with insurance companies to pre-certify/authorize/amend services.
• Actively participate in problem identification and coordinate resolution.
• Utilize proper communication system to facilitate communication with hospital partners.
• Research Patient Visit History to ensure compliance with payor specific payment window rules; appropriately communicate patient payment responsibilities and guide them through needed steps.

Qualifications

• High School Diploma or GED equivalent required.
• One year of related experience with medical insurance plans and/or Medicare benefits verification required.
• One-year medical clinic, urgent care, or hospital care setting experience preferred.
• Prior Authorization experience preferred.

Benefits

Rochester Primary Care offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services.
• Wellbeing support, including free counseling and referral services.
• Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence.
• Savings and retirement resources, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling.
• Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts.

Note: Eligibility for benefits may vary by location.