Authorization Coordinator

Job Description Job Description Description: Job: Authorization Coordinator Pay: $18-21/hr Position Summary: The Authorization Coordinator is responsible for reviewing, processing, and coordinating prior authorization and referral requests. This role ensures that all medical services comply with clinical guidelines, insurance benefit requirements, and regulatory standards. The Authorization Coordinator works closely with providers, members, and internal teams to ensure accurate and timely determinations. Primary Responsibilities * Determine Authorization Requirements Assess the need for prior authorization based on plan type, ICD-10 codes, CPT/HCPCS codes, and place of service. * Review Requests Review, research, and process referral and authorization requests, routing them according to established guidelines. * Provider & Member Communication Interact with providers and medical assistants to obtain complete and accurate information for processing authorizations and referrals. * Complex Case Escalation Consult with the Supervisor for difficult or complex authorization cases. * Cross-Department Communication Communicate effectively with medical support staff and internal departments to ensure timely and accurate processing. * Benefits & Contract Analysis Analyze referrals in accordance with patient insurance benefit limits and provider contract requirements. * Decision Processing Complete approval or denial determinations professionally, ensuring all actions are documented clearly. * Correspondence Management Send required correspondence to providers, their staff, and internal departments to obtain additional information or support appeal processes when needed. * Data Verification Confirm referral details including authorization maximums, limitations, and required documents. * Regulatory Compliance Maintain strict adherence to HIPAA and all privacy and security regulations. * Problem Resolution Identify issues within the authorization process and research alternative solutions as needed. * Team Collaboration Collaborate with team members to maintain efficient workflow and meet productivity and compliance standards. * Additional Tasks Perform other duties or special projects as assigned by the Supervisor or Manager. * Policy & Procedure Adherence Utilize all applicable policies, procedures, and reference materials when reviewing and processing authorization requests. * Accurate Documentation Maintain clear, accurate patient notes when a request is not approved, is pending additional information, or is routed for further review. Benefits: * Dental insurance * Disability insurance * Flexible spending