Prior Authorization Coord

The Prior Authorization Coordinator is an essential part of a multi-disciplinary team that provides high-quality patient care. The Prior Authorization Coordinator processes all inbound prior authorizations for the department. The Prior Authorization Coordinator will coordinate and ensure the smooth flow of the authorization process to meet the needs of our patients, community specialists, and physicians to represent a professional and positive experience. This candidate will review chart documentation to ensure the patient meets 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, and respond to clinic questions regarding payer medical policy guidelines. Candidates will also confirm the accuracy of CPT and ICD-10 diagnoses in the procedure order as well as maintain individual payer files to include up-to-date requirements needed to successfully obtain authorizations. The candidate must be at ease interacting with patients, physicians, and insurance companies to create relationships that will promote a pleasant and caring practice. This role also includes ensuring that other positions within the practice are being covered and providing a smooth and positive atmosphere for patients, physicians, and fellow workers.