Insurance Authorization Coordinator

Location: Raleigh, North Carolina - Midtown Pain and Spine Clinic

Status: Full-Time, Non-Exempt

Department: Midtown Pain and Spine - Administrative

Reports to: Practice Manager, Midtown Pain and Spine Clinic

Job Summary

The Insurance Authorization Coordinator is responsible for ensuring all procedures, diagnostic imaging orders and injectable medications are properly authorized with the insurance carrier prior to the patient’s appointment. The Insurance Authorization Coordinator will verify insurance coverage and benefits for scheduled procedures and inform the patient of their estimated out of pocket expense.

Responsibilities

• Complete pre-certification of procedures such as facet blocks, epidural injections, radiofrequency ablations, and spinal cord stimulators.
• Complete pre-certification of diagnostic imaging orders such as MRI and CT.
• Complete pre-certification of office administered injectable medication such as Botox and Xeomin.
• Coordinate deliveries with the specialty pharmacy.
• Review the procedure or test order and discuss with the provider any necessary information to approve and schedule appropriately.
• Document authorization information in the computer systems as required.
• Provide instructions to patients for their scheduled procedures.
• Work closely with providers to ensure procedures are scheduled correctly and in a timely manner.
• Communicate any changes as appropriate.
• Monitor the physician’s schedule for any added procedures or changes.
• Verify insurance eligibility and benefits for scheduled procedures and inform the patient of their estimated out of pocket expense.
• Achieve expert level knowledge of insurance authorization requirements for procedures and inform providers of any policy changes.
• Ability to read and comprehend medical documentation and apply to insurance requirements for authorization.
• Keep patients informed of authorization status.
• Schedule peer to peer reviews for denied procedures.
• Utilize independent judgment in planning, prioritizing and organizing workload.
• Maintain a pleasant and cooperative demeanor while performing all duties.
• Maintain an open line of professional communication with co-workers and providers regarding patient needs.
• Optimize patients’ satisfaction and providers’ time by following appointment scheduling guidelines.
• Follow HIPAA guidelines for protecting the confidentiality of patient information.
• Maintain operations by following policies and procedures.
• Perform other duties as assigned.

Qualifications

High school diploma/GED or equivalent previous experience. One to two years’ experience in medical authorizations, billing, or test scheduling is preferred.

Skills

• Excellent customer service skills
• Ability to prioritize job duties and multi-task
• Knowledge of deductibles and coinsurance
• Ability to handle high patient volumes in a professional manner
• Ability to maintain composure in stressful situations

Benefits

• Health, dental, and vision insurance
• Paid time off and holidays
• Retirement plan options
• Professional development and training opportunities

Schedule

Monday through Thursday 8:00AM-5:00PM, Friday 8:00AM-2:00PM