Authorization Coordinator - Remote

Job Description

Job Description

Job Summary:
The Authorization Coordinator is responsible for obtaining prior authorizations for medical procedures, diagnostic tests, and treatments to ensure timely access to care for patients at Pacific Cardiovascular Medical Group (PCMG). This role requires a thorough understanding of insurance policies, medical necessity criteria, and payer guidelines. By securing necessary authorizations, the Authorization Coordinator plays a critical role in preventing delays in patient care and minimizing financial risk for both the practice and patients. This position will collaborate closely with the invasive scheduling team and other cross-functional departments to ensure seamless coordination and efficiency.

Following the probationary and training period, this position will transition to remote work, with occasional in-office meetings as needed. We are committed to providing flexibility and will communicate any changes in advance to ensure a smooth transition.

Duties/Responsibilities:

• Verify insurance coverage and obtain prior authorizations for medical procedures, imaging studies, and specialty referrals.
• Communicate with insurance companies, healthcare providers, and patients to resolve authorization issues.
• Track authorization requests and ensure timely approvals to avoid delays in patient care.
• Maintain accurate and detailed documentation of authorization approvals, denials, and follow-ups within the electronic health record (EHR) system.
• Work closely with the Scheduling and Front Office teams to coordinate appointment scheduling based on authorization status.
• Assist in identifying trends in authorization denials and provide feedback to the Revenue Cycle Manager for process improvement.
• Educate patients on their insurance benefits and authorization requirements.
• Serve as a liaison between providers, insurance carriers, and patients to ensure smooth authorization processes.
• Assist with audits and reporting related to authorization processes and outcomes.
• Handle special projects as assigned by the Manager.

Required Skills/Abilities:

• Strong knowledge of insurance policies, prior authorization processes, and medical terminology.
• Excellent problem-solving and communication skills.
• Ability to work independently and manage multiple tasks efficiently.
• Proficiency in Microsoft Word, Excel, and Microsoft Outlook.
• Experience with NextGen or similar electronic health record (EHR) systems.

Education and Experience:

• High School Diploma or equivalent.
• Minimum of 2 years of experience in prior authorizations, medical billing, or revenue cycle management.
• Minimum of 3 years of strong customer service experience
• Experience working in a healthcare setting with insurance verification responsibilities preferred.

Physical Requirements:

• Must be able to work an 8-hour day with prolonged periods of sitting.
• Must be able to lift up to 15 pounds occasionally.

Pay Range: $22.00 - $25.00 per hour