Prior Authorization Coordinator

1 month ago


Wilson, North Carolina, United States LifePoint Health Full time
Prior Authorization Coordinator Job Description

The Prior Authorization Coordinator plays a vital role in our multi-disciplinary team, ensuring high-quality patient care. This position is responsible for processing all inbound prior authorizations for the department, coordinating the smooth flow of the authorization process, and meeting the needs of our patients, community specialists, and physicians.

Key Responsibilities:
  • Review chart documentation to ensure patients meet medical policy guidelines
  • Prioritize incoming authorization requests according to urgency
  • Obtain authorization via the payer website or by phone
  • Follow up regularly on pending cases
  • Initiate appeals for denied authorizations
  • Respond to clinic questions regarding payer medical policy guidelines
  • Confirm the accuracy of CPT and ICD-10 diagnoses in the procedure order
  • Maintain individual payer files, including up-to-date requirements needed to successfully obtain authorizations
Requirements:
  • Ability to interact with patients, physicians, and insurance companies to create relationships that promote a pleasant and caring practice
  • Responsible for patient and insurance verification using automated eligibility verification systems
  • Communicate with appropriate parties to obtain medical referrals/authorizations and ensure patient and insurance financial obligations are validated and met before patient's visit
  • Develop relationships with other Dr. Offices, maintain and foster a network of contacts for promoting practice services
  • Use Electronic Medical Records for scheduling/maintaining patient records and appointments
  • Ability to perform medical assistant and/or front desk responsibilities when needed (training would be provided)
Compliance and Security:

Employees acknowledge that compliance with CarePoint's HIPAA, Security, and Compliance Plan policies and procedures, as well as all other CarePoint policies and procedures, is a condition of employment. Any violation will result in sanctions up to and including termination based on the type and severity of the violation.

Access to and use of Protected Health Information – security clearance that allows employees to review, investigate, and respond to questions from payors.


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