Authorization Coordinator WFH

Work from Home; Nashville (TN); Remote; USD 42,000 - 61,000; Full time

Benefits offered by this job

Comprehensive benefits

Wellbeing support

Time away from work (PTO)

401(k) Plan with company match

Education assistance

Dependent scholarships

Job summary

HCA Healthcare is hiring an Authorization Coordinator to work from home, supporting timely pre-certifications and authorizations across payors. You will collect clinical data, apply authorization criteria, and monitor status in payer portals while ensuring accurate documentation and patient-focused service.

Ideal candidates have at least one year in medical insurance verification or prior authorization, with healthcare setting experience preferred.

Qualifications

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

Responsibilities

• Review and completion of prior authorizations to ensure timeliness of appointments, testing, procedures, and claims filing.
• Obtain clinical information such as medical history, diagnosis, and relevant lab reports to complete prior authorizations.
• Follow criteria for services requiring prior authorizations and submit requests in a timely manner.
• Track status of prior authorizations via payor portals.
• Review denied claims for clinical accuracy and resubmit with corrections.
• Communicate with insurance companies to pre-certify/authorize/amend services.
• Recommend new approaches and procedures to improve department efficiency.
• Coordinate resolution between appropriate parties and ensure documentation in billing systems.
• Research Patient Visit History to ensure payor payment window compliance and guide patient payments.
• Perform other related job functions and uphold Code of Conduct and Values.

Education

High School Diploma or GED

Job description

Experience the HCA Healthcare difference where colleagues are trusted, valued members of our healthcare team. Grow your career with an organization committed to delivering respectful, compassionate care, and where the unique and intrinsic worth of each individual is recognized. Authorization Coordinator WFH

Job Summary and Qualifications

The Authorization Coordinator is responsible for 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 portals

Reviews denied claims for clinical accuracy, corrects errors for claims resubmission.

Clearly support patient experience through patient-centered communications demonstrating excellent customer service skills

Communicate with insurance companies to pre-certify/authorize/amend services

Recommend new approaches, policies, and procedures to influence continuous improvements in department’s efficiency and services performed

Actively participate in problem identification and coordinates resolution between appropriate parties

Utilize appropriate communication system to facilitate communication with hospital partners

Ensure appropriate documentation is entered in standard format in billing system. This should be performed in the applicable Health Information System (i.e. Source systems) and if necessary, any other subsidiary systems if they are not automatically updated. — Is this redundant from bullet three? Could probably combine this one and bullet three into one statement.

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

Practice and adhere to the Code of Conduct and Mission, and Value Statements.

What 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/LICENSE:

None required

Work from Home, 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

Learn more about Employee Benefits

Note: Eligibility for benefits may vary by location.

Supporting HCA Healthcare’s 186 hospitals and 2,400+ sites of care, Physician Services plays a crucial role as the main entry point for patients looking for high-quality healthcare within the HCA Healthcare system. With a focus on meeting the needs of our patients at all access points, Physician Services is dedicated to implementing innovative, physician-driven, value-added solutions to assist physicians in providing high-quality, patient-centered care, aligning with our mission to care for and enhance human life.

HCA Healthcare has been recognized as one of the World’s Most Ethical Companies by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in costs for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

“There is so much good to do in the world and so many different ways to do it.”- Dr. Thomas Frist, Sr.

HCA Healthcare Co-Founder

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.