Authorization Coordinator

Sentara Hospitals • Norfolk, VA

2d • Remote

About The Position

Sentara Health is looking to hire an Authorization Coordinator. The Authorization Coordinator is responsible for review of clinical information received from Physicians and other Clinical providers ensuring clinical data is substantial enough to authorize services. Analyzes clinical information to ensure the services requested are authorized according to clinical protocols. Responsible for validation of member benefits for the services requested. Validates accuracy of insurance enrollment information in the system prior to authorizing services. Requires knowledge of managed care contracting, clinical protocols and clinical review requirements. Requires knowledge of regulatory and compliance requirements for government payers, self-funded and commercial payers. Ensures appropriate and accurate information is entered into claims system for processing payment. Related clinical experience as an LPN, such as experience in a physician office, acute care, managed care or clinic setting.

Requirements

• High School Diploma (required)
• Licensed Practical Nurse – LPN (required)
• 3 years of related experience (required)
• Knowledge of managed care contracting, clinical protocols and clinical review requirements.
• Knowledge of regulatory and compliance requirements for government payers, self-funded and commercial payers.
• Related clinical experience as an LPN, such as experience in a physician office, acute care, managed care or clinic setting.

Nice To Haves

• Utilization Management experience
• Diagnostic Imaging experience
• Microsoft Suite (Word, Excel, Outlook) preferred
• Milliman experience

Responsibilities

• Review of clinical information received from Physicians and other Clinical providers ensuring clinical data is substantial enough to authorize services.
• Analyze clinical information to ensure the services requested are authorized according to clinical protocols.
• Validation of member benefits for the services requested.
• Validate accuracy of insurance enrollment information in the system prior to authorizing services.
• Ensure appropriate and accurate information is entered into claims system for processing payment.

Benefits

• Medical, Dental, Vision plans
• Adoption, Fertility and Surrogacy Reimbursement up to $10,000
• Paid Time Off and Sick Leave
• Paid Parental & Family Caregiver Leave
• Emergency Backup Care
• Long-Term, Short-Term Disability, and Critical Illness plans
• Life Insurance
• 401k/403B with Employer Match
• Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education
• Student Debt Pay Down – $10,000
• Pet Insurance
• Legal Resources Plan
• Annual discretionary bonus if established system and employee eligibility criteria is met.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED