Authorization Coordinator

2 weeks ago


Urbana, Illinois, United States Carle Health Full time



Position Overview:

The Authorization Coordinator plays a crucial role in determining prior authorization necessities set by insurance providers and efficiently processes and finalizes authorizations for both scheduled and additional services. This position assesses whether services qualify as covered benefits and meticulously records pre-authorization details in the Epic system. The Coordinator also liaises with the referring Provider's office regarding approval or denial outcomes to minimize denials and facilitates peer-to-peer reviews when necessary.



Qualifications:

EDUCATIONAL BACKGROUND
No formal education required.

CERTIFICATION & LICENSURE
Completion of a Medical Terminology course within one year of employment.

EXPERIENCE
Preferred experience of at least one year in Healthcare or Insurance.

SKILLS AND COMPETENCIES
Excellent verbal and written communication abilities. Proficiency in learning and utilizing software applications is essential. Demonstrated capability to organize and prioritize tasks with a keen attention to detail and follow-up with minimal supervision. Ability to collaborate effectively with patients, nurses, and physicians in high-pressure situations. Capable of working independently and applying critical thinking skills in various insurance scenarios. Proficient in navigating multiple payer websites to ensure compliance with requirements. Ability to manage a high volume of pre-authorizations while multitasking efficiently.



Key Responsibilities:

  • Evaluates necessary information to finalize pre-authorizations based on diverse insurance/payer criteria; ensures accuracy of coverage/insurance details.
  • Effectively utilizes third-party payer/insurance portals to submit pre-authorization requests; possesses in-depth knowledge of insurance providers, their systems, and expectations for authorization approvals.
  • Thoroughly documents pre-authorization outcomes and communicates results to leadership, Providers, and/or Nurses regarding approvals or denials.
  • Advocates for patients and Providers by processing pre-authorizations promptly and collaborating with healthcare professionals to gather clinical information required for submissions.
  • Identifies challenges, trends, and patterns, working alongside management to address and resolve issues.
  • Performs additional duties as assigned.
  • Identifies prior authorization requirements set by insurance/payers and processes and completes authorizations for both scheduled and additional services.
  • Determines if services qualify as covered benefits and accurately documents pre-authorization information in Epic.
  • Communicates with the referring Provider's office regarding approval or denial of services to minimize denials and facilitates peer-to-peer reviews when necessary.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment based on race, color, sex, age, national origin, religion, sexual orientation, gender identity, veteran status, disability, or any other protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization.

Effective September 20, 2021, the COVID-19 vaccine is required for all new Carle Health team members. Requests for medical or religious exemptions will be permitted.



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