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Healthcare Authorization Coordinator

2 months ago

Oregon, Illinois, United States Utah Navajo Health System, Inc. Full time
Position Overview:
Utah Navajo Health System, Inc. is seeking a dedicated and detail-oriented individual to join our Compliance Team as a Healthcare Authorization Coordinator. This role is essential in ensuring that patients receive timely access to necessary healthcare services through effective management of prior authorizations for medications and diagnostic procedures.

Key Responsibilities:
  • Prior Authorization Management: Review and process prior authorization requests for medications, imaging studies, and other necessary procedures. Ensure all documentation is accurate and submitted promptly to insurance providers.
  • Patient Support: Assist patients in navigating medication programs and verify their eligibility for pharmaceutical assistance programs.
  • Insurance Coordination: Verify patients' insurance coverage, including formulary status and prior authorization requirements, to facilitate seamless access to care.
  • Documentation Collaboration: Work closely with healthcare providers to gather clinical documentation that supports the medical necessity of requested services.
  • Communication Facilitation: Act as the primary liaison between clinics, insurance companies, and patients regarding authorization status, ensuring all parties are informed throughout the process.
  • Advocacy: Advocate for patients' access to prescribed treatments by addressing insurance barriers and pursuing alternative coverage options when necessary.
  • Data Management: Maintain accurate records of authorization requests and outcomes, generating reports to identify trends and areas for improvement.
  • Policy Compliance: Stay updated on changes in insurance policies and ensure adherence to regulatory standards and organizational protocols.

Qualifications:
Applicants should possess a minimum of two years of experience in healthcare settings such as nursing, pharmacy, or patient care coordination. A thorough understanding of medical terminology, pharmacology, and insurance processes related to prior authorizations is essential. Strong communication skills and proficiency in electronic health records (EHR) systems are required.

Working Environment:
This position is based in one of the clinics within the Utah Navajo Health System. Standard office hours are maintained, with flexibility to accommodate urgent requests.

Licensure:
Applicants must hold the appropriate licensure relevant to their role, which may include Registered Nurse (RN), Licensed Practical Nurse (LPN), or Pharmacy Technician certification. Certification as a Prior Authorization Certified Specialist (PACS) is also required.

Join us in our mission to provide quality healthcare to the communities we serve, and be part of a team that values dedication and compassion.