Authorization Coordinator

Sentara Health Plans; Norfolk, Northern (VA, KY); Hybrid; USD 50,000 - 70,000; Full time

Benefits offered by this job

Medical insurance

Dental & Vision coverage

Paid Time Off

Parental leave

401k with employer match

Job summary

Sentara Health Plans in Norfolk, VA seeks an Authorization Coordinator to review clinical information from physicians to determine if services should be authorized, ensuring data supports decisions. This role analyzes data to ensure services are authorized per clinical protocols and validates member benefits before authorization.

The position requires a High School Diploma and LPN license with 3 years of related experience; utilization management and Milliman experience are preferred, along with

Qualifications

• High School Diploma required.
• LPN license required.
• 3 years of related experience required.
• Utilization Management experience preferred.
• Diagnostic Imaging experience preferred.
• Microsoft Office (Word, Excel, Outlook) preferred.
• Milliman experience preferred.

Responsibilities

• Review clinical information from physicians to determine authorization.
• Analyze data to ensure services are authorized per clinical protocols.
• Validate member benefits and enrollment data prior to authorization.

Skills

Utilization Management

Diagnostic Imaging

Microsoft Office

Milliman

Education

High School Diploma

Licensed Practical Nurse (LPN)

Tools

Milliman

Microsoft Office Suite

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.

Qualifications

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

• 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.

Sentara Health is a Virginia and Northeastern North Carolina based not-for-profit integrated healthcare provider that has been in business for over 131 years.

Offering hundreds of sites of care including 12 hospitals, PACE, home health, hospice, medical groups, imaging services, therapy, outpatient surgery centers, and an 858,000 member health plan.

The people of the communities that we serve have nominated Sentara “Employer of Choice” for over ten years.

U.S. News and World Report has recognized Sentara as having the Best Hospitals for 15+ years.

Sentara offers professional development and a continued employment philosophy!