Job Description

Job Description

Job Description

Description:

Job: Authorization Coordinator

Position Summary:
The Authorization Coordinator is responsible for reviewing, processing, and coordinating prior authorization and referral requests. This role ensures that all medical services comply with clinical guidelines, insurance benefit requirements, and regulatory standards. The Authorization Coordinator works closely with providers, members, and internal teams to ensure accurate and timely determinations.

Primary Responsibilities

1. Determine Authorization Requirements
   Assess the need for prior authorization based on plan type, ICD-10 codes, CPT/HCPCS codes, and place of service.
2. Review Requests
   Review, research, and process referral and authorization requests, routing them according to established guidelines.
3. Provider & Member Communication
   Interact with providers and medical assistants to obtain complete and accurate information for processing authorizations and referrals.
4. Complex Case Escalation
   Consult with the Supervisor for difficult or complex authorization cases.
5. Cross-Department Communication
   Communicate effectively with medical support staff and internal departments to ensure timely and accurate processing.
6. Benefits & Contract Analysis
   Analyze referrals in accordance with patient insurance benefit limits and provider contract requirements.
7. Decision Processing
   Complete approval or denial determinations professionally, ensuring all actions are documented clearly.
8. Correspondence Management
   Send required correspondence to providers, their staff, and internal departments to obtain additional information or support appeal processes when needed.
9. Data Verification
   Confirm referral details including authorization maximums, limitations, and required documents.
10. Regulatory Compliance
    Maintain strict adherence to HIPAA and all privacy and security regulations.
11. Problem Resolution
    Identify issues within the authorization process and research alternative solutions as needed.
12. Team Collaboration
    Collaborate with team members to maintain efficient workflow and meet productivity and compliance standards.
13. Additional Tasks
    Perform other duties or special projects as assigned by the Supervisor or Manager.
14. Policy & Procedure Adherence
    Utilize all applicable policies, procedures, and reference materials when reviewing and processing authorization requests.
15. Accurate Documentation
    Maintain clear, accurate patient notes when a request is not approved, is pending additional information, or is routed for further review.

Benefits:

• Dental insurance
• Disability insurance
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Experience:

• Insurance verification: 1 year (Preferred)
• Medical billing: 1 year (Preferred)

Work Location: In person

Join our team as an Authorization Coordinator , where you’ll review and process prior authorizations and referrals to support timely patient care. Ideal candidates have strong attention to detail, excellent communication skills, and experience working with insurance plans or medical terminology.

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