Authorization Coordinator

Sentara Health; Virginia (MN); On-site; USD 3,750,000 - 5,468,000; Full time

Benefits offered by this job

Medical plan

Dental plan

Vision plan

401k match

PTO

Job summary

Sentara Health is hiring an Authorization Coordinator in Norfolk, VA. The role reviews clinical data to determine authorization for services, validates member benefits, and ensures enrollment accuracy before processing payments. LPN background and utilization management experience are preferred, with familiarity in Milliman and MS Office.

The position requires a high school diploma and offers base compensation with comprehensive benefits as part of a full-time schedule.

Qualifications

• 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 and providers to determine authorization.
• Analyze data to ensure services are authorized per clinical protocols.
• Validate member benefits and enrollment accuracy prior to authorization.
• Enter accurate information into claims systems for processing.

Skills

LPN

Acute Care

Managed Care

Authorization Coordinator

Clinical Review

Utilization Management

Diagnostic Imaging

Education

High School Diploma

Tools

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.

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.

City/State

Norfolk, VA

Work Shift

First (Days)

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

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.

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.