Medical Authorization Coordinator
2 weeks ago
As the Medical Authorization Coordinator
Are you prepared to take the next step in your professional journey?
What you can expect...
Growth Potential – Abundant opportunities for advancement in your career
Work Schedule – Fully in-office position. Monday-Friday (8:30am-5:00pm)
Attractive Compensation - Starting at $21.00+ per hour
Streamlined Interview Process – Access to additional resume support and pre-interview guidance
Daily Responsibilities...
- Assess, process, and verify the medical necessity for each patient’s treatment and documentation in relation to adherence to established pathways
- Engage with nursing and medical personnel to communicate any limitations or specific requirements in line with insurance policies
- Provide timely feedback to physicians and management concerning documentation discrepancies and payer issues regarding non-covered medications
- Update coding and payer guidelines for clinical teams
- Monitor pathways and perform various administrative functions as needed, securing insurance authorization and pre-certification for services
- Investigate additional or alternative resources for non-covered services to mitigate payment denials
- Each Clinical Insurance Reviewer operates from a queue within their EMR system.
- They prioritize authorizations based on due dates or start dates provided by the healthcare provider.
- They first address their work queue before proceeding to authorization tasks.
- They must respond promptly to clinics, as they receive messages through the EMR, ensuring timely communication since treatment cannot proceed without CIR approval.
- They utilize insurance carrier portals, navigate pathways, and contact insurance companies to obtain authorizations for chemotherapy IV and injectable medications.
- They will enter authorization details into their EMR system, InoMed (G2), and their practice management software, Athena.
Essential Skills and Qualifications:
Insurance Authorizations | Insurance Verifications | Health Insurance Knowledge | ICD-10 Coding | CPT Coding | Medical Insurance Expertise | Medical Billing Acumen
Required Experience:
- Minimum of 1 year in prior authorization roles
- Familiarity with insurance payers
- Knowledge of payer websites
- Experience in Medical Billing or Accounts Receivable (as an alternative to authorization experience)
- Insurance Verification skills
We are partners in transformation. We assist clients in activating ideas and solutions to leverage a new world of opportunities. Our team of 80,000 collaborates with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe, and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with forward-thinking leaders to drive change. This is the essence of true partnership. TEKsystems is part of the Allegis Group.
The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information, or any characteristic protected by law.
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