Care Coordinator Prior Auth Specialist- Maternal Fetal Medicine

Advocate Aurora Health; Charlotte (NC); On-site; USD 40,000 - 55,000; Full time

Job summary

Advocate Health in Charlotte, NC seeks an Insurance Coordination Specialist to manage referrals, obtain authorizations, and educate patients on coverage. The role involves coordinating with multiple departments and practices to ensure timely services and minimize care gaps. Strong computer and customer service skills required.

Ideal candidates have a clinical background and prior authorization experience to support women's health services and complex care pathways.

Qualifications

• High School Diploma or GED required.
• Computer experience required.
• Understanding of Insurance coverage and Medical Necessity policies preferred.
• Knowledge of medical records software preferred.
• Customer service experience required.

Responsibilities

• Completes referrals for patients and coordinates with referring and receiving practices and/or departments.
• May coordinate and prepare financial estimates for patients.
• Obtains all authorizations needed.
• Directs patients to providers in their insurance plan.
• Reviews benefits and educates patient on insurance coverage.
• Coordinates and schedules surgical procedures, diagnostic testing, or other services within various departments with internal and ancillary providers.
• Reviews schedules and confirms schedules are accurate and time is properly allocated.
• Follows up on all referrals to ensure no care gaps.

Skills

Customer service

Education

High School Diploma or GED

Tools

Medical records software

Computer experience

Job description

Prefers Prior Auth. Experience; clinical background; women's experiences.

Essential Functions

• Completes referrals for patients and coordinates with referring and receiving practices and/or departments.
• May coordinate and prepare financial estimates for patients.
• Obtains all authorizations needed.
• Directs patients to providers in their insurance plan.
• Reviews benefits and educates patient on insurance coverage.
• Coordinates and schedules surgical procedures, diagnostic testing, or other services within various departments with internal and ancillary providers.
• Reviews schedules and confirms schedules are accurate and time is properly allocated.
• Follows up on all referrals to ensure no care gaps.

Physical Requirements

Must be able to sit for long periods of time and work in a fast-paced office environment. Should be able to bend and lift up to 10 lbs.

Education, Experience and Certifications

High School Diploma or GED required. Computer experience required. Thorough understanding of Insurance coverage (FSC/Coverage/Plan types) and Medical Necessity policies preferred. Knowledge of medical records software preferred. Customer service experience required.