The Authorization Coordinator is responsible for obtaining all necessary authorizations in accordance with established guidelines. Verifies eligibility, obtains benefit information, and generates letters for authorizations.

DUTIES AND RESPONSIBILITIES

• Responsible for verifying eligibility and benefits of patients requiring in-office or office visits.
• Responsible for requesting authorizations for cardiac rehab, sleep studies, radiology studies (CTs, MRIs), pulmonary function test, cardiac event monitors, other specialty consults, etc.
• Own full-cycle outside procedure referral process, including but not limited to orders, sending applicable records and contacting patients (except for hospital procedures).
• Responsible for explaining benefits to patients waiting to obtain authorization, communicating status and delays to physicians and back office.
• Requests and obtains authorization from insurance companies.
• Utilize NextGen EPM/EHR software to obtain authorization requests from physicians/medical assistants/LVNs
• Make follow-up inquiries via phone calls
• Maintains diagnosis/supporting information for authorization procedure. Issues authorizations number to service partners.
• Identifies fee for service/non-managed care patients, gets pre-authorization/ensures paperwork is scanned into patient’s chart.
• Generates monthly pre-authorization reports in accurate and timely manner.
• Utilizes computer databases (scheduling/PC/database) appropriately to facilitate member and staff inquires.
• Review and comply with the Code of Business Conduct and all applicable company policies and procedures, local, state and federal laws and regulations. Maintains patient’s dignity by protecting patient’s right to privacy, confidentiality, and safety.
• Other duties as assigned.

REQUIRMENTS

• High School Diploma required
• Associates or Bachelor’s degree preferred
• Certified Medical Assistant (CMA) through AAMA or NHA
• Knowledge of HMO/PPO Insurance information
• Ability to interpret and understand various medical insurance plans.
• Knowledge of ICD-10 codes and CPT codes.
• Knowledge of Medical terminology

Job Type: Full-time

Benefits:

• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Education:

• High school or equivalent (Required)

Experience:

• Patient care: 2 years (Required)
• Medical terminology: 1 year (Required)

License/Certification:

• Certified Medical Assistant (Preferred)

Work Location:

• One location

Work Remotely:

• No

Work Location: One location