Healthcare PreAuthorization Coordinator

Westside Family Healthcare Inc; Delaware; On-site; USD 42,000 - 52,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Life insurance

Short-term disability

401(k) retirement plan with match

PTO

Job summary

Westside Family Healthcare seeks a Preauthorization Coordinator to process prior authorizations and insurance referrals for specialty care, imaging, and diagnostics. You will support patients, providers, and coordinators, coordinating with medical neighbors to ensure timely access to care.

The role requires familiarity with CPT/ICD-10 codes, medical terminology, and experience with EMR systems. Westside emphasizes equal access to care and community health impact.

Qualifications

• High school diploma or GED required.
• One year of work experience in the medical/health insurance field.
• One year of experience using Microsoft Office software.
• One year of experience using electronic medical record software.
• Knowledge of CPT, ICD-10 codes and medical terminology.
• One year of experience processing prior authorizations and insurance referrals.

Responsibilities

• Process prior authorizations and insurance referrals for specialty care, imaging and diagnostic testing.
• Procure necessary documentation from patient records and health information partners.
• Document interactions accurately in the patient record.
• Communicate with providers when insurance requires peer review.
• Monitor and respond to inquiries related to prior authorizations.
• Maintain knowledge of payer requirements by monitoring websites/portals.

Education

High school diploma or GED

Tools

Microsoft Office

Electronic medical record (EMR) software

Job description

Description

WESTSIDE IS LOOKING FOR A PREAUTHORIZATION COORDINATOR TO JOIN THE TEAM!

JOIN THE TEAM THAT MAKES A DIFFERENCE!

Westside Family Healthcare is a nonprofit organization that provides high quality primary medical care without regard to ability to pay. The Preauthorization Coordinator processes prior authorizations and insurance referrals for specialty care, imaging and diagnostic testing for Westside Family Healthcare (“Westside”) patients, systematically supporting patients, providers and healthcare coordinators working with medical neighbors to coordinate care.

Since opening our doors in 1988, Westside has been driven by our mission to improve the health of our communities by providing equal access to quality healthcare. With 240 team members, five health centers, one mobile health unit and over 27,000 patients all across Delaware, Westside is committed to improving health, one patient, one family, one community at a time.

WORKING AT WESTSIDE MEANS WORKING IN A PRIMARY CARE MEDICAL HOME

A Primary Care Medical Home is not a special building. It is a way to provide healthcare that puts the patient at the center of health care decision-making. As a community health center, Westside Family Healthcare provides care for everyone who walks through our doors.

Our Mission:

To improve the health of our communities by providing equal access to quality healthcare

Our Vision:

Achieve health access for all

Our Values:

• Compassion: Lead with compassion
• Service: Serve with humility
• Excellence: Be exceptional
• Empowerment: Empower all people

OUR BENEFITS:

Our benefit package includes medical insurance (two plans to choose from), dental insurance (through Guardian Dental), vision insurance, life insurance paid by Westside with the option to purchase more paid, short-term disability paid for by Westside, long term disability paid by the employee, a 401(k) retirement plan with a match, and supplemental insurances. We offer a generous PTO package and flexibility to provide work/life balance. Westside Family Healthcare is an Equal Opportunity Employer that values diversity.

Responsibilities of the Preauthorization Coordinator:

1. Use web, phone and fax to process prior authorizations and insurance referrals for specialty care, imaging and diagnostic testing for all Westside patients, including out-of-network specialists and facilities.
2. Procure necessary documentation from the patient’s electronic medical record and local health information technology partners.
3. Document all interactions with patients, providers, payers, and other individuals on behalf of patients clearly, thoroughly and accurately in the patient’s medical record.
4. Communicate with Westside providers promptly when the insurance company requires a peer review.
5. Monitor and respond promptly to inbound calls and / or correspondence and documents related to prior authorization of patient care.
6. Maintain a working knowledge of prior authorization requirements by monitoring all payer websites/portals and communications.
7. Communicate with the billing department when a PCP change occurs as a result of the preauthorization process.
8. Perform data collection related to prior authorizations and insurance referrals, as assigned.
9. Follow organizational guidelines regarding the use of the Electronic Medical Record (EMR) in compliance with HIPPA and patient confidentiality standards.

Requirements

MINIMUM OBJECTIVE QUALIFICATIONS

1. High school diploma or GED
2. One year of work experience in the medical or health insurance field
3. One year of experience using Microsoft Office software
4. One year of experience using electronic medical record software
5. Knowledge of CPT, ICD 10 codes and medical terminology
6. One year of experience processing prior authorizations and insurance referrals