Healthcare Authorization Coordinator

2 weeks ago

Orange, California, United States The Midtown Group Full time
Job Overview

Our client, a reputable Healthcare Network based in California, is in search of a dedicated and experienced Healthcare Authorization Coordinator (Prior Authorization) to enhance their operations.

The Healthcare Authorization Coordinator will be responsible for managing office and referral processes, acting as a liaison among members, healthcare providers, and internal staff.

This role involves processing initial information intake, assisting with authorization tasks, and gathering necessary data. The Coordinator will evaluate and process requests for authorization and notifications of medical services from healthcare professionals, clinical facilities, and ancillary providers.

Key responsibilities include monitoring tasks related to prior authorization and referral procedures. The Coordinator will apply the network's medical criteria and policies to authorization or referral requests from healthcare professionals and facilities.

Direct interaction with provider callers is essential, serving as a resource for their inquiries. The Coordinator will operate under the guidance of a licensed nurse.



Telework eligibility is available for this position in Southern California.

The work schedule is Thursday through Monday, with Tuesday and Wednesday off.

Key Responsibilities:


85% - Medical Authorization: Receives referral requests via various channels and inputs new service request information into the authorization system. Collects additional data from members and providers to complete referral details. Authorizes requested services in accordance with established guidelines, performing data entry and verifying eligibility. Communicates with health networks and Customer Service regarding enrollments.

Assists Medical Case Managers in gathering medical records, obtains appropriate coding for diagnoses and procedures, and follows up on calls as directed by the authorization nurse.

Documents all interactions and case information in the system using standardized formats. Performs data entry into relevant databases for monitoring and tracking purposes.

10% - Administrative Support: Engages in a mission-driven culture focused on high-quality performance, emphasizing customer service, consistency, dignity, and accountability.

Collaborates with the team to fulfill departmental responsibilities and supports both short- and long-term departmental goals.

5% - Completes additional projects and tasks as assigned.



Minimum Qualifications:
High School diploma or equivalent required.
2 years of experience in a healthcare or managed care environment required.

An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position may also be qualifying.


Preferred Qualifications:
Bilingual in English and one of the defined threshold languages (Arabic, Chinese, Farsi, Korean, Spanish, Vietnamese).
Experience in prior authorization and utilization management processes.

Required Licensure / Certifications:
N/A

Knowledge & Abilities:


Ability to build rapport and maintain effective working relationships with leadership, staff, and external contacts across diverse backgrounds.

Demonstrate independence and sound judgment. Communicate clearly and concisely, both verbally and in writing. Flexibility in scheduling is required; availability for evening and weekend events is preferred.

Organizational, analytical, problem-solving, and project management skills are essential. Ability to work efficiently in a fast-paced environment and manage multiple projects while identifying opportunities for collaboration.

Proficient in utilizing computer software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job-specific applications to produce correspondence, charts, spreadsheets, and other relevant information.


Physical Requirements (With or Without Accommodations):
Ability to visually read information from computer screens, forms, and other printed materials. Ability to speak clearly in conversations and general communication. Hearing ability for verbal communication via telephone and face-to-face interactions. Manual dexterity for typing, writing, standing, and reaching, along with the ability to lift and move objects weighing 10 to 25 pounds.

Company Overview

Our client fosters a positive internal culture, providing ample opportunities for professional growth.

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