Prior Authorization Coordinator

Prior Authorization Coordinator At GI for Kids, you’ll play a key role in helping children access the care they need. As our Prior Authorization Coordinator, you’ll serve as the vital link between medical providers, insurance companies, and patient families—ensuring treatments and procedures are approved quickly, accurately, and with compassion. If you’re detail-oriented, love problem‑solving, and enjoy supporting both patients and clinical teams, this role may be perfect for you. Why You’ll Love Working Here No nights, weekends, or on‑call Monday–Friday, standard business hours Office closed for major holidays (paid holidays) Comprehensive benefits package, including: Medical, Dental, and Vision Insurance Generous PTO & Sick Time 401(k) with company match And more! What You’ll Do Verify Insurance Coverage – Confirm patient eligibility, benefits, co‑pays, and deductibles before services are scheduled. Submit Authorization Requests – Prepare and submit accurate, complete prior authorization requests using payer portals, fax, or phone, including all necessary clinical documentation, ICD‑10, CPT, and HCPCS codes. Track and Manage Status Updates – Follow up on pending authorizations, ensuring timely approvals and preventing delays in patient care. Handle Denials & Appeals – Review denial reasons and initiate appeals by gathering additional documentation or coordinating peer‑to‑peer reviews when needed. Communicate with Providers & Patients – Keep clinical staff updated on authorization status and help patients understand their insurance requirements and potential costs. Maintain Accurate Records – Enter and update authorization details in the EHR or Practice Management system for smooth billing and scheduling. Requirements Education High School Diploma or GED required Associate or bachelor’s degree in healthcare administration or related field preferred Experience 1–3 years in medical billing, insurance verification, prior authorization, or a clinical office setting Knowledge & Technical Skills Familiarity with medical terminology, anatomy, and coding (ICD‑10, CPT, HCPCS) Skilled in insurance portals such as Availity or CoverMyMeds Experience with EHR systems Essential Strengths Strong attention to detail and accuracy Excellent time management and organization Problem‑solving mindset with the ability to navigate complex insurance guidelines Clear, professional communication—both written and verbal #J-18808-Ljbffr University Physicians' Association, Inc. (UPA)