Authorization Coordinator

sentara; Norfolk (VA); On-site; USD 37,000 - 55,000; Full time

Benefits offered by this job

Medical, Dental, Vision plans

401k/403B with Employer Match

Paid Time Off and Sick Leave

Tuition Assistance

Job summary

Sentara Health in Norfolk, VA is seeking an Authorization Coordinator to review clinical information from physicians and other providers to determine if data supports service authorization. You will ensure data aligns with clinical protocols and validate member benefits for the requested services.

The role requires data accuracy in enrollment systems and entering information into the claims system. LPN experience in physician offices or acute care is preferred for this role.

Qualifications

• High School Diploma required.
• Licensed Practical Nurse (LPN) certification required.
• 3 years of related experience required.
• Utilization Management, diagnostic imaging, Milliman experience preferred.
• Related LPN clinical experience in physician offices, acute care, managed care or clinic setting preferred.

Responsibilities

• Review clinical information from physicians and clinical providers to determine if data supports authorization of services.
• Analyze clinical information to ensure authorization aligns with clinical protocols.
• Validate member benefits for requested services and confirm enrollment accuracy in the system.
• Enter accurate information into the claims system to support processing and payment.

Skills

LPN experience

Utilization Management

Diagnostic Imaging experience

Education

High School Diploma (required)

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Milliman

Job description

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

Compensation

We provide market-competitive compensation packages, inclusive of base pay, incentives, and benefits. The base pay range for full-time employment is $27.22 - $39.69 hourly.

Additional compensation may be available for this role, such as shift differentials, standby/on-call pay, overtime, shift premiums, extra-shift incentives, or bonus opportunities. Compensation within the range may vary based on qualifications, experience, location, market conditions, and business needs.

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.

Equal Opportunity Statement

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.

Health & Safety

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

Remote Locations

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.