Authorizations Coordinator

Michigan Orthopaedic Surgeons PLLC•Southfield, MI

About The Position

The Authorization Coordinator plays an essential role in supporting timely patient care by obtaining and managing insurance authorizations for a variety of services, including advanced imaging, pain management procedures, Durable Medical Equipment (DME), Physical Therapy (PT), Occupational Therapy (OT), medications, and other assigned services. This role works closely with insurance companies, physicians, clinical teams, scheduling staff, patients, and outside facilities to ensure authorization requirements are completed accurately and efficiently. Success in this role requires strong attention to detail, organization, communication, problem-solving skills, and the ability to manage multiple priorities in a fast-paced healthcare environment.

Requirements

High school diploma or GED.
Minimum one (1) year of experience with healthcare related authorizations.
Strong communication, organizational, and computer skills.

Nice To Haves

One (1) year of experience in submitting advanced imaging insurance authorizations.

Responsibilities

Obtain and submit prior authorizations for advanced imaging, pain management procedures, DME, PT/OT, medications, and other assigned services.
Review physician orders, clinical documentation, and payer requirements to ensure authorization requests are complete and accurate.
Monitor pending authorization requests and complete timely follow-up to prevent unnecessary delays in patient care.
Understand and follow payer-specific authorization requirements and organizational protocols.
Coordinate next steps for denials, appeals, peer-to-peer reviews, and requests for additional clinical information.
Maintain current knowledge of insurance guidelines and changes in authorization requirements.
Maintain accurate and thorough documentation of authorization activity, including submissions, status updates, authorization numbers, effective dates, payer communications, and reference information.
Verify authorization details are accurate and appropriate for the requested service, provider, facility, and date of service.
Communicate authorization approvals, denials, pending requirements, and other updates to physicians, clinical staff, patients, scheduling teams, and rendering facilities as appropriate.
Collaborate with multiple departments to obtain missing orders, clinical documentation, or other information needed to complete authorization requests.
Respond promptly and professionally to authorization-related questions and requests while helping resolve issues that could delay patient care.
Prioritize authorization requests based on urgency, date of service, payer requirements, and departmental protocols, including appropriate handling of urgent and STAT requests.
Maintain patient confidentiality and comply with HIPAA, organizational policies, and applicable regulations.
Participate in departmental training, cross-training, and process improvement initiatives and perform additional duties that support departmental operations.