Prior Authorization Coordinator

Midland-Health-2; Midland (TX); On-site; USD 45,000 - 65,000; Full time

Job summary

Midland-Health-2 is seeking a detail-oriented Prior Authorization Coordinator to determine client benefits, verify eligibility, and obtain and track authorizations for services in a fast-paced environment.

Responsibilities include contacting insurers, resolving coverage questions, documenting approval dates and codes in the patient profile, and coordinating scheduling with care teams. Proficiency with EMR and Microsoft Office is required.

Qualifications

• Experience with EMR and medical terminology
• 1+ year experience working with medical insurance and/or prior authorizations
• Excellent verbal and written communication skills
• Ability to work independently
• Strong passion for serving our clients
• Strong decision making/problem solving skills

Responsibilities

• Verify client benefits with insurance companies by phone or web.
• Obtain authorizations for services and track approvals.
• Answer coverage questions from providers, families, Revenue Cycle team.
• Use Microsoft Office and EMR in daily tasks.
• Verify benefits to ensure payment for services.
• Document authorization details in patient profile.
• Review denials and submit appeals as permitted by payor.
• Schedule surgeries and coordinate pre-admission tasks.
• Perform other Revenue Cycle duties as assigned.

Skills

EMR proficiency

Medical terminology

Verbal and written communication

Independent work

Customer service orientation

Tools

Microsoft Office

Electronic Health Records

Job description

Job Description

In this position you will determine client benefits and obtain and track client authorizations for services. People who are successful in this position will have a high attention to detail and be able to work in a fast-paced environment. Prior Authorization Coordinator is responsible for verifying patient-eligibility, coordinating benefits, and facilitating insurance coverage, as well as addressing patients' concerns regarding authorization and turnaround.

SHIFT AND SCHEDULE

FULL TIME: M-F 8:00 AM - 5:00 PM

ESSENTIAL FUNCTIONS/PERFORMANCE EXPECTATIONS

• Contacting insurance companies via phone and/or web to verify client s medical benefits
• Analyzing reports, tracking, and obtaining necessary authorizations for all services
• Answering insurance coverage and prior authorization questions from providers, families, and other Revenue Cycle members as needed
• Working with Microsoft office and Electronic Health Records
• Performing other duties to support Revenue Cycle operations as needed
• Ensure payment for services by verifying benefits with insurance provider.
• Document all prior authorization information including approval dates, billing units, procedure codes, and prior authorization number in patient profile
• Review insurance denials and submit appeals (as permitted by payor)
• Schedules surgeries by making arrangements with the surgical center; verifying times with patients; and preparing charts and pre-admission and consent forms.
• Perform all other duties as assigned

EDUCATION AND EXPERIENCE

• Experience with EMR (electronic medical records), medical terminology
• 1+ year experience working with medical insurance and/or prior authorizations
• Excellent verbal and written communication skills
• Ability to work independently
• Strong passion for serving our clients
• Strong decision making/problem solving skills

PHYSICAL REQUIREMENTS

To perform this job successfully, an individual must be able to perform each essential responsibility satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The individual must be able to:

• Stand, walk, sit, stoop, reach, lift, see, speak and hear. Lifting is limited to 35 lbs. for clinical staff and to 50 lbs. for non-clinical staff. The individual must use an assisted-lift device or get another individual(s) to assist with the lift that is over these maximum limits.
• Ability to work flexible schedules
• Ability to work under stress