Facilitate prior authorizations and documentation to support utilization review and reimbursement. Manage payer notifications, authorization/denial entries and escalations in the EMR, coordinate with Utilization Review nurses, business office and payers, schedule peer-to-peer reviews, and complete assigned goals and queues.
Job Summary
The Authorization Coordinator is responsible for facilitating information documentation and transmission vital to the effectiveness of utilization review and supporting Baptist’s reimbursement strategy. Specifically the managed care techniques the Coordinator uses focuses on prior authorization for services using evidence based criteria. Areas of work include payer notification, authorization management, denial management, escalations, and communication and coordination between payer, business office and UR Team.
Responsibilities
- Completes payer notification
- Communicates incorrect payer with patient access
- Communicate with Utilization Review Nurse
- Works assigned queues in the electronic medical record
- Documents next review dates in the electronic medical record
- Documents and updates authorized or denied information on auth/cert screen in the electronic medical record
- Schedules peer to peer when indicated
- Completes assigned goals
Specifications
Experience
Minimum Required
- 2 years’ clerical/support experience in a medical environment
Preferred/Desired
- Previous authorization coordinator experience
Education
Minimum Required
- High School Degree or equivalent
Preferred/Desired
- Bachelor’s degree
Training
Minimum Required
Preferred/Desired
Special Skills
Minimum Required
- Solid intermediate computer skills, Microsoft Office Suite; Knowledge of medical terminology and insurance; Accurate data entry
Preferred/Desired
Licensure
Minimum Required
Preferred/Desired
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