Authorization Coordinator

Full time (Monday - Friday, day shift), no nights, no on-call, no weekends, no holidays.

About the role

The Authorization Coordinator is responsible for timely and accurate processes associated with pre-certification, obtaining and certifying authorizations, and assisting with appeals of authorizations. Additionally, collaborates with the referral coordinator to ensure that all approvals are obtained.

Responsibilities

• Review and complete 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 and all needed systems.
• Track status of prior authorizations via payor authorization portals.
• Review denied claims for clinical accuracy, correct errors for claims resubmission.
• Support patient experience through patient-centered communications demonstrating excellent customer service skills.
• Communicate with insurance companies to pre-certify/authorize/amend services.
• Recommend new approaches, policies, and procedures to influence continuous improvements in department's efficiency and services performed.
• Actively participate in problem identification and coordinate resolution between appropriate parties.
• Utilize appropriate communication systems 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.
• Perform other related job functions as assigned.
• Practice and adhere to the Code of Conduct and Mission and Value Statements.

Qualifications

• Education: High School Diploma or GED equivalent required.
• Experience: 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.
• Certification/License: None required.

Benefits

TriStar Joint Replacement Institute 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.
• Education support through tuition assistance, student loan assistance, certification support, dependent scholarships, and a partnership with Galen College of Nursing.
• 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.