Medical Insurance Authorization Coordinator

Medical Insurance Authorization CoordinatorNashville Fertility Center

Job Title: Medical Insurance Authorization Coordinator

Department: Billing Department
Reports To: Billing Manager
FLSA Status: Non-Exempt
Job Type: Full-Time

GENERAL JOB DESCRIPTION

The Medical Insurance Authorization Coordinator at Nashville Fertility Center is responsible for obtaining insurance authorizations for IUI and IVF medical procedures, verifying benefits, and ensuring accurate insurance processing. This role involves working closely with insurance companies and clinical staff to ensure patients receive the necessary authorizations for their treatments. The Coordinator also handles GAP/NAP submissions for out-of-network coverage and provides backup support to the insurance verification and billing departments.

MAJOR DUTIES AND RESPONSIBILITES

• Insurance Authorization:
• Initiate contact with insurance companies’ authorization departments for IVF and IUI cycles.
• Provide timely and accurate insurance authorization requests once the treatment plan is decided, ensuring patients can make informed decisions regarding the cost associated with their treatment.
• Obtain clinical information from patient charts to determine medical necessity.
• Follow up on all authorization requests to ensure a timely response from the insurance company.
• Coordination and Communication:
• Work closely with the clinic, IVF Financial Coordinator, and billing department to ensure seamless coordination between authorizations, cycle starts, and billing processes, including handling approvals and denials.
• Request GAP/NAP exceptions for out-of-network laboratory and surgery centers, if applicable.
• Communicate insurance coverage details with Nashville Fertility Center’s business office as needed.
• Backup Responsibilities:
• Serve as a backup for insurance verification, including entering benefits information into the EMR system.
• Handle patient account inquiries and manage billing calls as needed.
• General Duties:
• Post patient payments accurately and in a timely manner to their accounts.
• Maintain accurate and detailed records of all insurance authorizations, billing activities, and communications.
• Ensure compliance with all state and federal regulations regarding insurance authorizations, billing practices, and patient privacy (HIPAA).
• Perform all other duties as assigned.

QUALIFICATIONS FOR THE JOB

· High School Diploma or equivalent required; associate or bachelor’s degree in a related field preferred.

· Minimum of 2 years of experience in medical insurance verification, pre-certification, or authorization in a healthcare setting required.

· Experience in a fertility, OB/GYN, or specialty clinic is a plus.

· Excellent communication and interpersonal skills, with the ability to interact effectively with patients, visitors, and staff.

· Ability to maintain composure and professionalism in stressful situations.

· Strong organizational skills and attention to detail, with the ability to multitask in a fast-paced environment.

· Proficiency in computer skills, including Microsoft Office and electronic medical records systems.

· Certification in Medical Billing and Coding (CMBS, CPC) is a plus but not required.

· Understanding medical terminology and procedures is advantageous.

· Reliable and punctual with a strong work ethic.

· Ability to maintain confidentiality and adhere to HIPAA regulations

KEY COMPETENCIES

· Strong understanding of medical insurance processes and terminology.

· Excellent communication skills, both verbal and written.

· Proficient in using electronic medical records (EMR) and insurance verification systems.

· Ability to work independently and manage multiple tasks efficiently.

· Detail-oriented with strong organizational and problem-solving skills.

Job Type: Full-time

Pay: $18.00 - $22.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Vision insurance

Experience:

• Medical billing: 1 year (Preferred)
• Insurance Pre- Authorization: 1 year (Required)

Ability to Commute:

• Nashville, TN 37203 (Required)

Work Location: In person

Salary : $18 - $22