Coordinator, Prior Authorization

This position works with a team of professionals responsible for obtaining prior authorization before services are rendered for requested procedures, testing, and medications. Responsibilities also include the coordination and scheduling of certain procedures and tests. This role collaborates with physicians, nurses, clinic managers, and financial advocates to resolve issues that arise during the prior authorizations process. A high level of computer literacy for daily navigation through multiple electronic systems, troubleshooting, and task completion is necessary. Excellent communication and collaboration are vital for completing responsibilities efficiently and timely.

Responsibilities

• Verifies insurance eligibility, benefits, and network status.
• Ensures accurate ICD, CPT codes and related medical records are submitted in the authorization request.
• Obtains pre-authorization and referrals from insurance companies for diagnostic testing, procedures, treatments, and medication as ordered by healthcare providers.
• Follows up on delayed or denied authorization requests and escalates for resolution.
• Creates detailed documentation and maintains/stores the authorization paper trail.
• Depending on the area of assignment, coordinates schedules for surgery, surgical procedures, testing, and other services as requested and in accordance with departmental policy and procedures.
• Effectively works with other team members to complete tasks efficiently and collaboratively.
• Participates in quality improvement projects by developing data collection tools, analyzing, compiling, and reporting data, and providing input to the QI process.

Work Environment

• Nearly Continuously: Office environment, sitting, hearing, listening, talking.
• Often: Repetitive hand motion (such as typing), walking.
• Seldom: Bending, reaching overhead.

The staff member must demonstrate knowledge and skills necessary to provide care appropriate to the age of patients served. The individual must demonstrate knowledge of the principles of life span growth and development and the ability to assess data regarding patient status and provide care as described in the department's policies and procedures manual.

Requirements

• Three years of experience working in an office or clinic, with an emphasis in scheduling, or a related area, or equivalency (one year of education can be substituted for two years of related work experience).
• Demonstrated effective communication, human relations, and computer skills.
• Some areas of assignment require completion of a medical terminology course, certification related to a specific area, and/or additional years of related experience.
• This position is patient-sensitive and must fulfill all associated requirements, including immunization according to CDC standards and hospital policy. Limited exemptions may be made for documented medical contraindications or religious beliefs that object to vaccinations.

Preferences

• Previous experience with medical insurance, prior-authorizations, and ICD/CPT coding.

Benefits

• Excellent health care coverage at affordable rates.
• 14.2% retirement contributions.
• Generous paid leave time.
• 11 paid holidays per year.
• 50% tuition reduction for employees, spouses, and dependent children.
• University-provided basic employee life insurance coverage equal to a salary of up to $25,000.
• Variety of elective insurance coverage, including life insurance, short- and long-term disability, accidental death & dismemberment, accident, critical illness, hospital indemnity, and pet insurance.
• Free transit on most UTA services.
• Employee discounts on a variety of products and services, including cell phones & plans, entertainment, health and fitness, restaurants, retail, and travel.
• Professional development opportunities.

Pay

$14.42 - $21.29 per hour.

Schedule

Full-time, Monday through Friday scheduled shifts from 8:00 am to 5:00 pm or 9:00 am to 6:00 pm. Assigned shift as needed based on operational needs.