Authorization Coordinator

About Our Client

The organization operates within the healthcare sector, specifically providing pediatric care. It focuses on combining advanced technologies and family-centered approaches to deliver specialized medical services for children. The organization emphasizes continuous education for caregivers and maintains state-of-the-art facilities to support its mission of healing children and families.

About the Opportunity

The Authorization Coordinator role supports the financial clearance of scheduled medical services by managing authorizations within the department. This position serves as a resource for resolving complex referral and authorization issues, ensuring compliance with hospital practices and policies. The role contributes to minimizing financial risks and enhancing coordination among providers, payers, and clinical staff.

Responsibilities

• Provide day-to-day financial clearance of scheduled services assigned to the Authorization department.
• Serve as a resource on complex referral and authorization issues for problem resolution.
• Act as a patient and family advocate between providers and payer authorization requirements.
• Collaborate with providers and staff to facilitate referral and authorization success.
• Track authorization status, follow-ups, and payer issues on patient accounts.
• Assist team members in prioritizing urgent cases and securing authorizations.
• Process authorizations involving denials, peer-to-peer reviews, or additional medical justification.
• Follow up on and correct authorizations requiring further research or resubmission.
• Ensure timely clearance of authorization claims edits according to organizational standards.
• Investigate, resolve, and document insurance issues efficiently.
• Coordinate with contracting for patients with non-contracted coverage.
• Inform management of potential deferrals or denials of service requests prior to service dates.
• Communicate with clinical staff to assist with insurance issue resolution.

Requirements

• High school diploma or GED equivalent.
• Two years of directly related experience.
• Ability to analyze operational and procedural problems and recommend solutions.
• Effective written and verbal communication skills.
• Ability to work with individuals at all organizational levels.
• Knowledge of computer systems and software relevant to the function.
• Knowledge of medical terminology.
• Familiarity with Medicare, Medi-Cal, Workers Compensation, Managed Care plans, and Children's Health Programs.

Pay

Minimum to Midpoint Range (Hourly): $34.06 to $42.57