Authorization Coordinator

COPE Health Solutions

2d • $25 - $29 • Remote

About The Position

The Authorization Coordinator works under general supervision and plays a key role in maintaining efficient UM operations, ensuring regulatory compliance, and supporting high – quality member service.

Requirements

• Minimum 2–3 years of experience in healthcare customer service, authorization processing, or utilization management
• Experience working in a Managed Care or Health Plan environment
• Familiarity with prior authorization workflows
• Strong written and verbal communication skills
• Prior experience in Utilization Management intake or prior authorization within a health plan

Responsibilities

• Creates and modifies authorizations and/or orders for new and existing Members in an accurate and timely matter
• Researches, troubleshoots, resolves authorization and/or order processing issues and discrepancies
• Completes activities, including but not limited to, inbound/outbound calls, as assigned, faxes and emails
• Obtains information from internal and external sources. Processes or triages the request via our medical management information system or external sources
• Coordinates with Providers and Members regarding authorization requests and/or activities
• Communicates with Care Management, Member Services, Membership and Eligibility and other internal departments regarding Member services, authorization requests and issues
• Reviews all authorization requests for accuracy and prioritizing based on urgency
• Documents communication, actions taken and barriers in the Medical Management System as it pertains to the Members Care or request for services
• Utilizes internal and external systems to verify eligibility and Provider Information such as name, address, fax number, NPI and TAX ID.
• Conducts follow-up, as necessary, to ensure member satisfaction and successful delivery of service
• Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
• Participates in special projects and performs other duties as required

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed