Authorization Coordinator
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.
Requirements
- High School Diploma (required)
- Licensed Practical Nurse – LPN (required)
- 3 years of related experience (required)
Nice To Haves
- Utilization Management experience (preferred)
- Diagnostic Imaging experience (preferred)
- Microsoft Suite (Word, Excel, Outlook) preferred
- Milliman experience (preferred)
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.
- Validation of 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.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
