Authorization Coordinator

TakeCare Insurance Company, Inc. • Tamuning, GU

2d

About The Position

The Authorization Coordinator is responsible for collecting, processing, and monitoring routine to moderately complex referrals and healthcare services data. This role involves verifying benefits for customers to improve services, adhering to established policies, procedures, and guidelines. The position reports directly to the Lead Authorization Coordinator.

Requirements

• High School diploma or equivalent.
• Minimum of 2 years of experience with an impressive track record in collecting, processing, and monitoring routine to moderate complex referrals and health care services data.
• Effective team player with very good interpersonal relationship skills; able to work and relate well with co-employees, patients, and customers.
• Must possess behavioral sensitivity, maturity, diplomacy, and tact in addressing complex situations and handling irate customers.
• Outstanding oral and written communication skills.
• Strong ethics and a high level of personal and professional integrity.
• Basic familiarity with federal and state laws and requirements relating to healthcare management.
• Computer literate and highly proficient in using MS Office programs.

Responsibilities

• Inputs and processes authorization requests and auto-authorizations per guidelines and according to defined time and accuracy standards.
• Ensures correct and consistent application of decision support systems such as Medical Management Guidelines and Milliman Care Guidelines.
• Provides customers with verification of eligibility, interpretation of benefits, and appropriate contracted provider/facility information.
• Maintains effective communication with inpatient facilities, providers, and other UM/CM staff.
• Screens and troubleshoots calls regarding member care within the scope of a non-clinical position, routing calls outside that scope to the appropriate department.
• Administers reports and maintains files of correspondence, denial and appeal logs, and documentation to support report status and clinical workflow.
• Applies appropriate contracted, negotiated, or DRG rates using established criteria.
• Performs other duties as assigned.

What This Job Offers

• Career Level: Mid Level
• Education Level: High school or GED