Authorization Coordinator

Sentara Health; Norfolk (VA); On-site; USD 55,000 - 70,000; Full time

Benefits offered by this job

Medical, Dental, Vision plans

Paid Time Off and Sick Leave

401k/403B with Employer Match

Tuition Assistance – $5,250/year

Job summary

Sentara Health in Norfolk, VA is seeking an Authorization Coordinator to review clinical information from physicians and other providers, ensuring data supports service authorization according to clinical protocols.

The role requires a Licensed Practical Nurse (LPN), a High School diploma, at least 3 years of related experience, and familiarity with utilization management, regulatory requirements, and Milliman. Proficiency in Microsoft Word, Excel, and Outlook is preferred.

Qualifications

• 3 years of related experience (required)
• Utilization Management experience (preferred)
• Diagnostic Imaging experience (preferred)
• Microsoft Suite (Word, Excel, Outlook) preferred
• Milliman experience (preferred)

Responsibilities

• Review clinical information to authorize services according to clinical protocols.
• Validate member benefits and enrollment information prior to authorization.

Skills

Utilization Management

Clinical Review

Regulatory Compliance

Education

High School Diploma

Licensed Practical Nurse – LPN

Tools

Microsoft Word

Microsoft Excel

Outlook

Milliman

Job description

Overview

Sentara Health is looking to hire an Authorization Coordinator.

The Authorization Coordinator is responsible for review of clinical information received from Physicians and other Clinical providers ensuring clinical data is substantial enough to authorize services. Analyzes clinical information to ensure the services requested are authorized according to clinical protocols. Responsible for validation of member benefits for the services requested. Validates accuracy of insurance enrollment information in the system prior to authorizing services. Requires knowledge of managed care contracting, clinical protocols and clinical review requirements. Requires knowledge of regulatory and compliance requirements for government payers, self-funded and commercial payers. Ensures appropriate and accurate information is entered into claims system for processing payment.

City/State

Norfolk, VA

Work Shift

First (Days)

Overview

Sentara Health is looking to hire an Authorization Coordinator.

The Authorization Coordinator is responsible for review of clinical information received from Physicians and other Clinical providers ensuring clinical data is substantial enough to authorize services. Analyzes clinical information to ensure the services requested are authorized according to clinical protocols. Responsible for validation of member benefits for the services requested. Validates accuracy of insurance enrollment information in the system prior to authorizing services. Requires knowledge of managed care contracting, clinical protocols and clinical review requirements. Requires knowledge of regulatory and compliance requirements for government payers, self-funded and commercial payers. Ensures appropriate and accurate information is entered into claims system for processing payment. Related clinical experience as an LPN, such as experience in a physician office, acute care, managed care or clinic setting.

Education

• High School Diploma (required)

Certification

• Licensed Practical Nurse – LPN (required)

Experience

• 3 years of related experience (required)
• Utilization Management experience (preferred)
• Diagnostic Imaging experience (preferred)
• Microsoft Suite (Word, Excel, Outlook) preferred
• Milliman experience (preferred)

Keywords: Talroo- Health, LPN, Acute Care, Managed Care, Authorization Coordinator, Clinical Review, Utilization Management, Diagnostic Imaging experience, Milliman

Benefits: Caring For Your Family and Your Career

• Medical, Dental, Vision plans
• Adoption, Fertility and Surrogacy Reimbursement up to $10,000
• Paid Time Off and Sick Leave
• Paid Parental & Family Caregiver Leave
• Emergency Backup Care
• Long-Term, Short-Term Disability, and Critical Illness plans
• Life Insurance
• 401k/403B with Employer Match
• Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education
• Student Debt Pay Down – $10,000
• Pet Insurance
• Legal Resources Plan
• Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.

Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.

In support of our mission “to improve health every day,” this is a tobacco-free environment.

For positions that are available as remote work,

Sentara Health employs associates in the following states:

Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.