The Authorization Coordinator is responsible for researching, verifying, and reviewing members' eligibility for all prior authorization (PA) requests received in the Utilization Management (UM) department. Uploads member demographics, processes prior and auto authorizations, follows up with providers for additional information, and redirects out of network requests. Facilitates the PA process as well as communicates authorization status to physician's office and members. Ensures that services are provided in a timely and cost-effective manner per UM policy and procedure.
- Work Schedule: Monday through Friday, 8:00 AM – 5:00 PM (aligns with standard business hours).
- Key Traits for Success: Candidates must be flexible and fluid. The health plan space changes rapidly and is rarely strictly "black and white," so adaptability and teamwork are crucial
- Daily Workflow: Highly sedentary and repetitive. The coordinator will spend most of the day sitting in front of a computer screen reviewing and processing authorizations.
- Training & Onboarding: Initial onboarding training takes 3 to 6 months to fully understand the processes. The team will provide ongoing support throughout and after this period.
- Accountabilities:
- Research and process prior authorization requests.
- Verify eligibility and benefits of members.
- Perform data entry, prioritizes, and processes auto authorizations.
- Monitor and follow-up on open or pended authorizations.
- Enter demographic information into the system and update information.
- Prepare and maintain logs and reports.
- Respond to and process urgent/stat authorization requests.
- Maintain confidentiality and discretion in use of member information.