Insurance Authorization Coordinator I

Primary Responsibilities

• Authorization Coordination: Request and obtain preauthorization for assigned specialties, cover for other workflows, submit required documentation, and follow up to ensure timely approvals.
• Insurance Verification: Verify patients' insurance coverage, eligibility, demographics, benefits, and financial responsibility to determine if prior authorization is required for specific medical procedures or treatments.
• Policy Knowledge: Stay updated with insurance policies, guidelines, and procedures related to authorization and reimbursement processes.
• Appointment Management: Properly process appointment or add-on changes, date changes, and impactful service changes requiring immediate review.
• Communication: Communicate with patients, their families, and healthcare professionals to update on authorization requests, address questions or concerns, and ensure a smooth process for all parties involved.
• Documentation and Record-Keeping: Maintain accurate and detailed records of authorization requests, approvals, denials, and related correspondence.
• Collaboration: Work with healthcare providers, physicians, clinical staff, and other departments to support obtaining authorizations and reimbursement.
• Problem-Solving: Identify and address barriers or challenges during the authorization process, such as resolving denials, appealing decisions, or finding alternative solutions for patients' medical needs.
• Team Participation: Attend and participate in daily departmental huddles to report on payer issues, workflow barriers, and specific issues affecting authorization and reimbursement.

Requirements

• About 1 year of specialized training beyond high school
• Minimum of 6 months of Insurance Authorization experience required

About Us

Nemours Children's Health is an internationally recognized pediatric health system serving more than 1.7 million patient encounters each year. We deliver care across six states through two freestanding children’s hospitals — Nemours Children's Hospital, Delaware and Nemours Children's Hospital, Florida — along with a network of more than 80 primary, urgent, and specialty care practices and more than 40 hospital partnerships. Backed by the Nemours Foundation and Alfred I. duPont Trust, our $1.7B nonprofit system is dedicated to improving children's health through clinical care, research, education, advocacy, and prevention. Our Whole Child Health approach focuses equally on prevention and treatment, partnering with communities to help every child thrive. Inclusion and belonging guide our strategy and growth. We are committed to culturally relevant care, reducing health disparities, and fostering an environment where every associate, patient, and family feels supported and valued.