Prior Authorization Coordinator

Job Description

JOB DETAILS

REQUIREMENTS

• High School Diploma or GED (required)
• Minimum of 1 year of prior authorization and clinical setting experience (required)
• Experience working within Pain Management required
• Proficient in Microsoft Office Suite
• Strong analytical and problem-solving abilities
• Excellent organizational skills and attention to detail
• Knowledge of HIPAA privacy and security requirements
• Basic understanding of medical terminology
• Familiarity with payor portals and medical policy navigation
• Must be able to sit for extended periods, communicate clearly, perform computer-based tasks, occasionally lift up to 25 lbs, and maintain close vision, depth perception, and focus adjustment.

RESPONSIBILITIES

• Monitor advanced procedure trackers for each practice to identify authorization opportunities.
• Collect all required documentation for prior authorizations.
• Review medical necessity guidelines for procedures by Paycor.
• Accurately and promptly submit prior and retro authorization requests to payors.
• Document account activity, updating patient and claim information to ensure efficient claim processing.
• Identify trends or issues that delay authorization or claims processing.
• Communicate with practices, vendors, insurance companies, patients, and management to secure necessary approvals.
• Provide the highest level of customer service to internal teams.
• Serve as a backup to the Contact Center Team during peak scheduling call times.
• Perform other related duties as assigned to support smooth operations and patient care continuity.

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