Authorization Coordinator WFH

HCA Healthcare•Nashville, TN

1d•Remote

About The Position

The Authorization Coordinator is responsible for timely and accurate prior authorization and pre-certification processes, obtaining and certifying authorizations, and assisting with authorization appeals. The role collaborates with the referral coordinator to ensure approvals are obtained. This is a work-from-home position, and the employee must reside in San Antonio. The coordinator reviews and completes prior authorizations, gathers clinical information, follows payer criteria, submits requests on time, and tracks authorization status through payer portals. The role ensures accurate documentation in billing and applicable health information systems, reviews denied claims for clinical accuracy, and corrects errors for resubmission. It also involves communicating with insurers and patients, researching patient visit history to confirm payer payment-window compliance, explaining patient payment responsibilities, and helping patients complete necessary steps. The coordinator supports continuous improvement, identifies and helps resolve problems, facilitates communication with hospital partners, and performs other related duties as assigned. The role requires adherence to the organization’s Code of Conduct, Mission, and Value Statements.

Requirements

High school diploma or GED equivalent.
One year of related experience with medical insurance plans and/or Medicare benefits verification.

Nice To Haves

One year of experience in a medical clinic, urgent care, or hospital care setting preferred.
Prior Authorization experience preferred.

Responsibilities

Review and complete prior authorizations to support timely appointments, testing, procedures, and claims filing.
Obtain clinical information, including medical history, diagnosis, and relevant lab reports, required for prior authorization and insurance requirements.
Follow criteria for services requiring prior authorization and submit requests in a timely manner.
Enter appropriate documentation in the standard billing system and applicable Health Information System or other subsidiary systems.
Track prior authorization status through payer authorization portals.
Review denied claims for clinical accuracy, correct errors, and resubmit claims.
Communicate with patients in a patient-centered manner and provide excellent customer service.
Communicate with insurance companies to pre-certify, authorize, or amend services.
Recommend approaches, policies, and procedures to improve departmental efficiency and services.
Identify problems and coordinate resolution among appropriate parties.
Use appropriate communication systems to facilitate communication with hospital partners.
Research patient visit history to ensure compliance with payer-specific payment-window rules.
Communicate patient payment responsibilities and guide patients through necessary steps.
Perform other related job functions as assigned.
Adhere to the Code of Conduct and Mission and Value Statements.

Benefits

Comprehensive medical, prescription drug, dental, vision, behavioral health, and telemedicine benefits.
Wellbeing support, including free counseling and referral services.
Paid time off, paid family leave, long- and short-term disability coverage, and leaves of absence.
401(k) plan with a 100% match on 3% to 9% of pay, based on years of service.
Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support, and financial wellbeing counseling.
Tuition assistance, student loan assistance, certification support, dependent scholarships, and a partnership with Galen College of Nursing.
Fertility and family-building benefits and adoption assistance.
Life insurance and supplemental health protection plans.
Auto and home insurance, legal counseling, identity theft protection, and consumer discounts.
Work from home.