Prior Authorization Coordinator Full Time NEW

Benefits: Medical, Dental, Vision, STD, LTD, Life, PTO, Paid Holidays, 4% 401k Match

Position Summary  

The Prior Authorization Coordinator is responsible for obtaining insurance benefits and prior authorizations for procedures performed at the surgery center. This role involves submitting and following up on authorization requests, ensuring compliance with medical policy guidelines, and collaborating with clinical staff, physicians, and insurance representatives. The coordinator ensures that authorization processes are handled efficiently, minimizing delays and denials, while maintaining patient confidentiality and contributing to a professional work environment. 

Essential Duties and Responsibilities 

The essential functions include, but are not limited to the following: 

Manage, monitor, update, and respond to authorization orders within Authorization Tracker (Athena) to ensure timely processing and accurate documentation of prior authorization requests. 

Initiate and prioritize authorization requests for upcoming procedures via websites, payor portals, telephone, etc. as needed. 

Document the status of prior authorization requests into the EMR system. 

Research and understand general medical policy guidelines for commonly performed procedures. 

Review patient chart documentation to ensure compliance with medical policy guidelines. 

Initiate appeals and peer-to-peer reviews for denied authorizations. 

Respond to clinical staff questions regarding medical policy guidelines and requirements. 

Work alongside the Business Office Director to maintain and publish medical policy guidelines. 

Secure patient information and maintain confidentiality according to HIPAA and other regulations. 

Participate in regular fire, disaster, and mock drills as required. 

Adhere to Pain Care’s uniform policy (business casual) and call-in/unplanned leave policies to ensure smooth workflow for the team. 

Contribute to a positive, inclusive, and professional work environment by promoting teamwork, avoiding gossip, and engaging in constructive problem-solving. 

Demonstrate excellent customer service when interacting with patients, explaining insurance coverage, and handling difficult situations with empathy and professionalism. 

Perform other duties as assigned. 

Minimum Qualifications (Knowledge, Skills, and Abilities) 

High School Diploma or GED; Associate degree preferred. 

Minimum two (2) years of experience in an ambulatory clinic or medical office setting, preferably in pain management. 

Experience with EMR systems (Greenway preferred). 

Knowledge of healthcare regulations, including HIPAA confidentiality and infection control measures.