Prior Authorization Coordinator

4 days ago


Orange, California, United States Regal Medical Group Full time
Job Summary

The Prior Authorization Coordinator will play a crucial role in facilitating the referral process, ensuring that patients receive the right care at the right time in the right setting. This position requires strong organizational skills, attention to detail, and the ability to work in a fast-paced environment.

Key Responsibilities
  • Referral Processing: Process requests from Access Express, including pended or reprocessed approved or denied authorizations, and package them properly for review and resolution.
  • Eligibility and Benefits: Check eligibility and benefits on all DME and home health authorizations prior to forwarding them to the prior authorization nurse or medical director for approval.
  • Turnaround Time Compliance: Maintain turnaround time compliance in all aspects of the Prior Authorization process.
  • Communication: Effectively handle all incoming provider calls, including the most challenging provider offices, and identify trends with provider offices.
  • Problem-Solving: Solve complex prior authorization questions and issues, and identify opportunities for improvement and make recommendations for change.
  • Collaboration: Work in collaboration with the department Prior Auth Assistants, Specialists, Team Leads, Supervisor, Managers, and Regional Medical Directors and Network Managers to ensure a level of referral processing that meets or exceeds the organization's expectation.
Requirements
  • Education: High School graduate required; Associates in Arts degree preferred.
  • Experience: 1-2 years IPA or Medical office experience, with experience in prior authorization process strongly preferred.
  • Skills: Proficient in MS Office programs, typing 60 words per minute with accuracy, and strong organizational skills and attention to detail.


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