Authorization Coordinator: JR-104720

Sentara Health; United States; Remote; USD 42,000 - 60,000; Full time

Job summary

Sentara Health is seeking an Authorization Coordinator to review clinical information from physicians and other providers to determine if services can be authorized under clinical protocols.

The role ensures validation of member benefits and enrollment information, and requires knowledge of regulatory compliance for payers. Data is entered into the claims system to support timely payment.

Qualifications

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

Responsibilities

• Review clinical information from Physicians and other clinical providers to determine data sufficiency for authorization.
• Analyze information to ensure services are authorized according to clinical protocols.
• Validate member benefits and enrollment data prior to authorization.
• Enter accurate information into the claims system for processing payments.

Skills

Clinical data review

Regulatory compliance

Data entry

Utilization Management (preferred)

Education

High School Diploma

LPN Certification

Tools

Microsoft Word

Microsoft Excel

Outlook

Milliman

Job description

Remote

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

LPN

Experience

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