Authorization Coordinator

Responsible for review of the clinical information received from physicians, department queues and other clinical providers, ensuring clinical data is substantial enough to authorize services for both 1 time visit account types and recurring accounts. Analyzes clinical information to ensure the services requested are authorized according to clinical and payer protocols. Responsible for insurance verification, member benefits, obtaining authorizations and pre-registration for the services requested. Validates accuracy of insurance enrollment information in the system prior to authorizing services, making certain policy is active. Requires knowledge of managed care contracting, clinical protocols and clinical review requirements. Requires knowledge of regulatory and compliance requirements, for both government and commercial payers. Ensures appropriate and accurate information is entered into systems for processing of patient care and reimbursement. Acts as a liaison between patients, physicians, clinical department and insurance companies. Responsible to secure high volume less complex authorization work as determined by payer behavior, time needed to authorize, opportunity research and key performance indicators. Required to have knowledge in modality and payer behavior. Accountable to problem solve, investigate and help resolve problems for work assignment. Must collaborate effectively with internal and external teams to reach desired results as determined by key performance indicators and leadership. Medical Terminology and ICD-10 knowledge required. Must be able to obtain and ensure timely authorizations, meeting the needs of patient care. Ability to prioritize and expedite authorizations with payer and/or medical management companies. Recognizing priority for late notice patient testing. This position works directly with clinical staff to schedule procedures, arrange treatment plans, request peer to peer and obtain retro authorizations. Also works with financial aid for patients without coverage.