Prior Authorization Coord

The Prior Authorization Coordinator is an essential part of a multi-disciplinary team that provides high-quality patient care. The Prior Authorization Coordinator processes all inbound prior authorizations for the department. The Prior Authorization Coordinator will coordinate and ensure the smooth flow of the authorization process to meet the needs of our patients, community specialists, and physicians to represent a professional and positive experience. This candidate will review chart documentation to ensure the patient meets medical policy guidelines, prioritize incoming authorization requests according to urgency, obtain authorization via the payer website or by phone, follow up regularly on pending cases, initiate appeals for denied authorizations, and respond to clinic questions regarding payer medical policy guidelines. Candidates will also confirm the accuracy of CPT and ICD-10 diagnoses in the procedure order as well as maintain individual payer files to include up-to-date requirements needed to successfully obtain authorizations. The candidate must be at ease interacting with patients, physicians, and insurance companies to create relationships that will promote a pleasant and caring practice. This role also includes ensuring that other positions within the practice are being covered and providing a smooth and positive atmosphere for patients, physicians, and fellow workers.

Responsible for patient and insurance verification using automated eligibility verification systems Communicate with appropriate parties to obtain medical referrals/authorizations and ensure patient and insurance financial obligations are validated and met before patient’s visit Develop relationships with other Dr. Offices, maintain and foster network of contacts for promoting practice services Use Electronic Medical Records for scheduling/maintaining patient records and appointments Ability to do medical assistant and/or front desk responsibilities when needed (training would be provided) Other duties may be assigned if determined in the best interest of the Practice
Compliance, HIPAA, and Security Employees acknowledge that compliance with CarePoint’s HIPAA, Security and Compliance Plan policies and procedures as well as all other CarePoint policies and procedures is a condition of employment and that any violation will result in sanctions up to and including termination based on the type and severity of the violation. Access to and use of Protected Health Information – security clearance that allows employees to review, investigate, and respond to questions from payors.

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Organization: Wilson Physician Services

Title: Prior Authorization Coord

Location: NC-Wilson

Requisition ID: 7462-9139