Prior Authorization & Denials Coordinator

The Staff Pad•Las Vegas, NM

12d

About The Position

The Prior Authorization & Denials Coordinator is responsible for managing prior authorizations for medical services, procedures, and medications, as well as overseeing denied claims to ensure timely reimbursement. This role serves as a liaison between healthcare providers, insurance companies, and patients—helping to ensure that authorization requirements are met and denials are resolved efficiently.

Requirements

High school diploma or equivalent required; Associate’s or Bachelor’s degree preferred
Minimum of 2 years of experience in healthcare billing, utilization management, or a medical office setting
Prior experience with authorization and denial management is strongly preferred
Knowledge of insurance carriers, medical terminology, and coding (CPT, ICD -10)
Excellent organizational and multitasking skills
Strong written and verbal communication abilities
Proficient in EHR systems, practice management software, and Microsoft Office
Detail -oriented with strong problem -solving and analytical skills

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 necessary information for appeals
Track status and outcomes of appeals, maintaining organized records
Maintain strict confidentiality of all patient and financial information
Provide updates to providers, staff, and patients regarding authorization and denial statuses
Educate internal teams on authorization and denial best practices
Serve as a subject matter expert for 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