Prior Authorization & Medical Necessity Specialist

Peoplefluent; Lansing, Northern (MI, KY); Hybrid; USD 42,000 - 56,000; Full time

Job summary

University of Michigan Health-Sparrow is seeking an Medical Necessity & Authorization Coordinator in Lansing, MI. The role focuses on obtaining financial authorization prior to services, working with insurance payers and clinical staff to secure payment and improve cash flow.

Essential duties include determining authorization requirements, communicating with payers, collecting patient financial responsibility, and coordinating with multiple departments to resolve authorization-related issues.

Qualifications

• Requires medical terminology understanding and strong customer service skills.
• Knowledge of health insurance verification processes and payer requirements.
• Experience with EPIC, Passport and Outlook is preferred.

Responsibilities

• Obtain financial authorization prior to services.
• Coordinate with insurance companies and clinical staff for authorizations.
• Educate clinicians and staff about authorization processes and requirements.
• Verify insurance eligibility and benefits; collect prepayment when needed.
• Register patients and manage scheduling/pre-registration data related to authorization.

Skills

Medical Terminology

Customer Service

Analytical Assessments

Education

Associates degree in health field

Tools

EPIC

Passport

Microsoft Outlook

Job description

University of Michigan Health-Sparrow is seeking an Medical Necessity & Authorization Coordinator in Lansing, MI. The role focuses on obtaining financial authorization prior to services, working with insurance payers and clinical staff to secure payment and improve cash flow.

Essential duties include determining authorization requirements, communicating with payers, collecting patient financial responsibility, and coordinating with multiple departments to resolve authorization-related issues.