Prior Authorization Coordinator

Community Health Network of Connecticut, Inc; Wallingford (CT); Remote; USD 51,000 - 68,000; Full time

Benefits offered by this job

Medical/Dental/Vision

FSAs/HSAs

Life insurance

401(k) with match

Tuition reimbursement

Paid leave & holidays

Wellness program

Job summary

Community Health Network of Connecticut, Inc. is seeking a Prior Authorization Coordinator in Wallingford, CT. The role focuses on medical necessity reviews, benefit determinations, and coordination of authorizations for CHNCT members.

You will engage with providers, utilize InterQual/Medicaid criteria, and prepare denial letters while supporting education of clinicians and staff. A licensed practical nurse with 3–5 years of experience is preferred.

Qualifications

• Two years post-secondary schooling as a base requirement.
• Active Licensed Practical Nurse License is required.
• 3 to 5 years of related experience in healthcare administration.

Responsibilities

• Responds to telephonic and written requests for authorization and coverage.
• Conducts medical necessity reviews for DME and procedures.
• Identifies coordination of benefits and third party liability as needed.
• Uses InterQual/Medicaid criteria to support decisions.
• Prints and proofreads denial letters and forwards appropriately.
• Educates providers on CHNCT policies and procedures.

Education

Associate's degree

Licensed practical nursing

3-5 years experience

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Regular Full Time High Remote Full-Time, Wallingford, CT, US 1 Attachments

Salary Range: $51,075.00 To $68,100.00 Annually

Community Health Network of Connecticut, Inc. (CHNCT) is currently seeking a Prior Authorization Coordinator to join our team.

Primary Responsibilities

• Works collaboratively with Health Services’ staff in conducting medical necessity review
• Approves or denies services based on benefit package and medical necessity criteria.

Tasks Performed

• Responds to telephonic and written requests by CHNCT providers for authorization and benefit coverage for CHNCT members.
• Conducts medical necessity review of requests for DME, outpatient therapies and prior authorizations for inpatient and outpatient procedures.
• Identifies need for coordination of benefits and identifies third party liability as appropriate.
• Utilizes the InterQual and or Medicaid criteria to make decisions.
• Selects, formats, proofreads and prints appropriate member and provider denial letters prior to mailing.
• Refers cases to CHNCT Medical Reviewer when clinical information does not support medical necessity.
• Assists in education of primary care providers, specialists and ancillary providers on CHNCT policies and procedures.
• Performs other duties as assigned.

Essential Functions

• Maintains knowledge of covered benefits for Medicaid programs.
• Shares information as necessary with appropriate clinical staff.
• Identifies and refers cases appropriate for Intensive Care Management evaluation.
• Identifies authorization issues and brings those requiring attention to the Manager for resolution.
• Reviews requests for non-par services and approves or denies based on guidelines/policies.
• Reviews requests for services not included in member’s benefit package.

Desired Education

Two years post-secondary schooling

Desired Degree

Associate's degree

Desired Major

Licensedpractical nursing

Desired Job Experience

3 to 5 years’ related experience

Certifications Required

Active Licensed Practical Nurse License

• Medical, dental and vision coverage options
• Flexible spending and health savings accounts
• Group term life insurance
• A 401(k) plan with company-match and immediate vesting
• Voluntary accidental injury coverage
• Tuition reimbursement and continuing education opportunities
• A generous paid-leave bank and company holidays
• Wellness program

We are dedicated to having a workplace where everyone feels valued, respected, and empowered to succeed. We embrace a wide range of perspectives and backgrounds, ensuring fair treatment and opportunities for all employees. We value our team’s rich array of experiences and viewpoints, which contribute to our innovative and collaborative environment.

We are committed to providing an inclusive and accessible interview process. If you require a reasonable accommodation for your interview due to a disability. Please contact us in advance if you need an accommodation.

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