Authorization Coordinator

About the Role

Full time (Monday - Friday, day shift), no nights, no on-call, no weekends, no holidays. The Authorization Coordinator is responsible for timely and accurate processes associated with pre-certification, obtaining and certifying authorizations, assisting with appeals of authorizations, and collaborating with the referral coordinator to ensure all approvals are obtained.

Responsibilities

• Review and complete prior authorizations to ensure timeliness of appointments, testing, procedures, and claims filing.
• Obtain clinical information (including medical history, diagnosis, and relevant lab reports) necessary to complete the Prior Authorization, including insurance requirements.
• Follow 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 the status of prior authorizations via payer authorization portals.
• Review denied claims for clinical accuracy and 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 efficiency and services.
• 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 payer-specific payment window rules, 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

• 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.