Authorization Coordinator

HCA Healthcare; Rochester (NH); On-site; USD 36,000 - 48,000; Full time

Benefits offered by this job

Comprehensive benefits package

Wellbeing and counseling resources

401(k) with company match

Tuition and education support

Paid time off and family leave

Job summary

HCA Healthcare's Rochester Primary Care is seeking a Clerical Documentation Assistant to support prior authorizations and clinical data gathering. You will ensure timely authorizations, gather medical information, and liaise with insurers to facilitate services for patients.

The role emphasizes accurate documentation, patient-centered communication, and collaboration with the referral and billing teams in a fast-paced clinic setting.

Qualifications

• High school diploma or GED is required.
• One year of experience with medical insurance plans or Medicare benefits verification.
• Prior authorization experience is preferred.

Responsibilities

• Review and complete prior authorizations to ensure timely appointments, testing, and claims.
• Obtain clinical information (history, diagnosis, labs) to complete authorizations.
• Submit requests promptly and document in the standard billing systems.
• Track status of authorizations via payer portals.
• Review denied claims and resubmit with corrected information.
• Support patient experience through clear, patient-centered communication.
• Communicate with insurers to pre-certify/authorize/amend services.
• Identify and help coordinate problem resolutions with partners.

Skills

Medical insurance verification

Prior Authorization

Customer service

Education

High School Diploma or GED

Job description

Are you passionate about the patient experience? At HCA Healthcare, we are committed to caring for patients with purpose and integrity. We care like family! Jump-start your career as a Clerical Documentation Assistant today with Rochester Primary Care.

Job Summary and Qualifications

The Authorization Coordinator handles timely and accurate processes associated with some or all of the following job duties: pre-certification, obtaining and certifying authorizations, assisting with appeals of authorizations. Additionally, collaborates with the referral coordinator to ensure that all approvals are obtained.

What you will do in this role:

• Responsible for review and completion of prior authorizations to ensure timeliness of appointments, testing, procedures, and claims filing.
• Obtain clinical information (including but not limited to medical history, diagnosis, and any relevant lab reports) necessary to complete the Prior Authorization to include insurance requirements.
• Follow the criteria for all services requiring prior authorizations and submit requests in a timely manner. Ensure appropriate documentation is entered into the standard billing system. Ensuring that this documentation entry is performed in all needed systems.
• Tracks status of prior authorizations via payor authorization portal.
• Reviews denied claims for clinical accuracy, corrects errors for claims resubmission.
• Clearly support patient experience through patient-centered communications proving excellent customer service skills.
• Communicate with insurance companies to pre-certify/authorize/amend services.
• Actively participate in problem identification and coordinate resolution.
• Utilize proper communication system to facilitate communication with hospital partners.
• Research Patient Visit History to ensure compliance with payor specific payment window rules; appropriately communicate patient payment responsibilities and guide them through needed steps.
• Performs other related job functions as assigned.

Qualifications you will need

Education:

• High School Diploma or GED equivalent required

Experience:

• One year of related experience with medical insurance plans and/or Medicare benefits verification required.
• One-year medical clinic, urgent care, or hospital care setting experience preferred.
• Prior Authorization experience preferred.

Certification/Licence:

• None
• High School Graduate / GED

Benefits

Rochester Primary Care offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services.
• Wellbeing support, including free counseling and referral services.
• Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence.
• Savings and retirement resources, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling.
• Education support through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing.
• Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts.

Note: Eligibility for benefits may vary by location.

We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.