Overview

The Authorization Coordinator plays a key role in the patient experience and Revenue Cycle of the organization. This position will work with service providers and insurance companies to obtain all necessary prior authorizations. To be successful in this position you will need to thrive in a fast pace environment, be detail oriented, flexible, highly organized, self-motivated and muse provide outstanding service to both internal and external customers. Being a positive team player is a must.

Responsibilities

• Review structured clinical data, matching it against specific medical terms and diagnoses or procedure codes and follow established procedures for authorizing request. Refer request for further review and follow-up on pending authorizations and appeals of rejected authorizations in a timely manner.
• Review and evaluate inpatient and outpatient admissions and procedures to ensure that appropriate and necessary authorization is obtained.
• Obtain and verify insurance benefits and other sources of account payment, making corrections when needed and document in appropriate EMR.
• Document in the appropriate EMR details of the authorization and insurance benefits information. Ensure that the service area or practice is aware that an authorization has been obtained or denied.
• Collaborate with patients, service providers, and insurance carriers to resolve questions that may delay or prevent authorization.
• Assist in the development and maintenance of prior authorization procedure manual.
• Assist in the collection and maintenance of prior authorization statistics; i.e. authorization request, authorizations obtained and denial information.
• Other assignments or projects as needed.

Qualifications

Education Required:

• High School Diploma or Equivalent

Education Desired:

• Associates Degree or Certification in Medical Office Management, Medical Coding, or CRCS-I or an equivalent combination of education and experience from which knowledge and skills would be acquired.

Experience Requirements:

• Three years' working in a physician or hospital administrative support setting.

Experience Desired:

• Three years prior-authorization experience in physician practice or hospital setting.