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Insurance Authorization Coordinator

2 months ago

Oregon, Illinois, United States Croix Health Full time
St. Croix Health is seeking a dedicated full-time (1.0 FTE) Insurance Authorization Coordinator to enhance our Business Office team.
This role operates Monday through Friday during daytime hours.
Initial training will occur on-site, with the possibility of remote work after successful completion of training. Remote employees must reside within a reasonable commuting distance for necessary on-site meetings and training sessions.

Position Overview:


The Insurance Authorization Coordinator is tasked with the organization, prioritization, and oversight of daily operational functions related to verifying insurance benefits. This includes securing precertification/preauthorization from payers for various medical services such as specialty medications, in-clinic procedures, podiatry orthotics, surgical interventions, pain management injections, advanced imaging (MRI, CT, Echo, Nuc Med), sleep studies, behavioral health consultations, inpatient admissions, and rehabilitation services.


Key Responsibilities:


- Prepare, organize, prioritize, document, and communicate all necessary information and paperwork required by insurance companies for the authorization process.
- Verify provider orders, patient eligibility, and submission protocols per payer requirements.
- Independently complete tasks promptly to ensure prior authorization is secured.
- Minimize denials through accurate prior authorization submissions.
- Act as a resource and liaison for both staff and patients.
- Foster and maintain strong relationships with all payer groups.
- Continuously research and stay informed on payer requirements for prior authorization.
- Share relevant information with appropriate staff members.
- Update guidance documents as necessary.
- Verify benefits, including medical necessity, and communicate findings with the relevant department and/or patient. Serve as a resource for staff and patients regarding medical necessity and authorization inquiries.
- Ensure all pertinent information regarding prior authorization is accurately documented in the electronic health record system.
- Address patient concerns and inquiries promptly, ensuring clarity and understanding.
- Collaborate effectively with all departments to resolve issues and answer questions.


Qualifications:
Education:
- High School diploma or GED required.

Experience:
- Minimum of 3 years in Medical Customer Service or 2 years in healthcare with insurance and/or prior authorization experience required.
- Previous experience with insurance and third-party payers is preferred.
- Familiarity with CPT and ICD-10 coding is required.
- Formal education in medical terminology or equivalent experience is necessary.
- Recent experience with EPIC/Excellian is preferred.

Skills and Abilities:
- Exceptional communication and listening skills.
- Proven ability to work independently with minimal supervision while managing multiple priorities effectively.

Physical Requirements:
- Prolonged periods of sitting at a desk and working on a computer.
- Ability to lift up to 15 pounds occasionally.

About St. Croix Health:
St. Croix Health is a not-for-profit healthcare organization committed to enhancing the health and well-being of our community. We offer a comprehensive benefits package, including health, vision, and dental insurance, a 403b retirement plan with employer matching, paid time off, and various insurance options. Our mission is to help individuals lead healthier, happier, and longer lives, and we are dedicated to transforming healthcare into a sustainable and affordable model.