Preauthorization Coordinator - Drive Patient Care Access

RiseMe; New Castle (DE); On-site; USD 42,000 - 54,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Life insurance paid by employer

Short-term disability

Long-term disability paid by employee

401(k) with match

Supplemental insurances

Generous PTO

Work/life balance

Equal Opportunity Employer

Job summary

Westside Family Healthcare is seeking a Preauthorization Coordinator to join our nonprofit team in Delaware. You will process prior authorizations and referrals, gather necessary medical records, and document interactions in the EMR to support patients, providers, and healthcare partners.

You will liaise with insurers on peer reviews and ensure timely responses to inquiries. The role emphasizes accurate data collection, payer knowledge, and collaboration with billing for PCP changes, within our

Qualifications

• High school diploma or GED required.
• 1 year of medical or health insurance experience.
• 1 year of experience using Microsoft Office.
• 1 year of experience with electronic medical records.
• Knowledge of CPT and ICD-10 codes and medical terminology.
• 1 year of experience processing prior authorizations and referrals.

Responsibilities

• Process prior authorizations and referrals for specialty care, imaging, and diagnostics for Westside patients.
• Obtain needed documentation from patient records and IT partners.
• Document all interactions clearly in the patient record.
• Communicate with providers when peer reviews are required by insurers.
• Respond promptly to calls and correspondence related to authorizations.
• Maintain knowledge of payer requirements via portals and communications.
• Coordinate PCP changes with the billing department post-authorization.
• Collect data related to prior authorizations and referrals.
• Follow HIPAA and confidentiality guidelines in EMR use.

Skills

Medical insurance experience

Microsoft Office

EMR software

CPT/ICD-10 knowledge

Communication skills

Education

High school diploma or GED

Tools

EMR software

Microsoft Office

Job description

Westside Family Healthcare is seeking a Preauthorization Coordinator to join our nonprofit team in Delaware. You will process prior authorizations and referrals, gather necessary medical records, and document interactions in the EMR to support patients, providers, and healthcare partners.

You will liaise with insurers on peer reviews and ensure timely responses to inquiries. The role emphasizes accurate data collection, payer knowledge, and collaboration with billing for PCP changes, within our