Prior Authorization & Denials Coordinator - Full-Time | Days

The Staff Pad•Las Vegas, NM

About The Position

The Prior Authorization & Denials Coordinator joins the Registration/Patient Access Team at a healthcare organization in Las Vegas, New Mexico. The role manages prior authorizations for medical services, procedures, and medications and oversees denied claims to support timely reimbursement. It serves as a liaison among healthcare providers, insurance companies, and patients to ensure authorization requirements are met and denials are resolved efficiently. The coordinator obtains authorizations, verifies insurance eligibility and benefits, tracks pending requests, and follows up for timely approvals. The role also reviews denied claims, identifies root causes and appeal opportunities, prepares and submits appeals, and tracks their status and outcomes. It works with billing, coding, clinical teams, providers, staff, and patients, while maintaining confidential and accurate records and supporting compliance, audits, reporting, and quality assurance.

Requirements

High school diploma or equivalent required.
At least 2 years of experience in healthcare billing, utilization management, or a medical office setting.
Knowledge of insurance carriers, medical terminology, and coding, including CPT and ICD-10.
Excellent organizational and multitasking skills.
Strong written and verbal communication abilities.
Proficiency with EHR systems, practice management software, and Microsoft Office.
Detail-oriented, with strong problem-solving and analytical skills.

Nice To Haves

Associate’s or Bachelor’s degree.
Prior experience with authorization and denial management.
Previous acute care hospital experience.

Responsibilities

Obtain prior authorizations for outpatient procedures, diagnostic testing, and specialty medications.
Verify insurance eligibility, benefits, and authorization requirements for scheduled services.
Communicate with insurance companies, physician offices, and patients to secure required documentation.
Track pending authorizations and follow up to ensure timely approvals.
Review and analyze denied claims to determine root causes and appeal opportunities.
Prepare and submit appeals with appropriate documentation and clinical justification.
Collaborate with billing, coding, and clinical teams to gather information for appeals.
Track appeal status and outcomes and maintain organized records.
Maintain strict confidentiality of patient and financial information.
Provide providers, staff, and patients with updates on authorization and denial statuses.
Educate internal teams on authorization and denial best practices.
Serve as a subject matter expert on payer-specific policies and insurance guidelines.
Ensure compliance with payer policies, HIPAA, and regulatory standards.
Maintain accurate records and logs for audits and quality assurance.
Generate regular reports on authorization status, denial trends, and appeal outcomes.