Prior Authorization Coordinator (Benefits)

Job Description

Provide efficient and accurate information to prior authorization requests. Ensure that correct benefits, co-pays and financial responsibility are provided to Prior Auth requestors.

Education and/or Experience:

• 2-4 years of experience with HMO referrals and prior authorizations.
• Knowledge of Healthcare and Managed Care preferred.
• Typing 40 words per minutes with accuracy.
• Knowledge of computers, faxes, printers and all other equipment.
• Proficient in MS Office programs (i.e., Word, Excel, Outlook, Access and Power Point).
• Ability to multi-task and meet deadlines.
  
  

Essential Duties and Responsibilities include the following:

• Anticipate our customer needs: Understand the process and job guidelines in order to provide accurate and in timely manner information to Prior Auth department so they can properly authorized or deny services based on coordinators findings.
• Data entry via GCEA/REA
• Verify eligibility and benefits on all requests from Prior Authorization.
• Verify financial responsibility for all requests.
• Maintain turnaround time compliance in all aspects of the UM process.
• Maintain all reference material that is provided by the supervisor, manager or director.
• Know and follow the Employee Handbook policies and procedures.
• Maintain patient confidentiality so that HIPAA compliance is observed at all times.
• Demonstrates honesty and integrity in everyday activities.
• Recognizes when an error has been made and immediately reports to appropriate manager.
• Maintain regulatory turn-around Time Standards per CMS (Seniors) and ICE (Commercial).
• Assists other staff and supports the team approach.
• Participates in the efficient, effective, and responsible use of resources such as supplies and equipment.
• Communicates appropriately and clearly to management and co-workers.
• All other duties as directed by management.
  
  

The pay range for this position at commencement of employment is expected to be between $23 - $25 per hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

If hired, employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

Full Time Position Benefits:

The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members. As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.

Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.

Health and Wellness:

• Employer-paid comprehensive medical, pharmacy, and dental for employees
• Vision insurance
• Zero co-payments for employed physician office visits
• Flexible Spending Account (FSA)
• Employer-Paid Life Insurance
• Employee Assistance Program (EAP)
• Behavioral Health Services
  
  

Savings and Retirement:

• 401k Retirement Savings Plan
• Income Protection Insurance
  
  

Other Benefits:

• Vacation Time
• Company celebrations
• Employee Assistance Program
• Employee Referral Bonus
• Tuition Reimbursement
• License Renewal CEU Cost Reimbursement Program
• Business-casual working environment
• Sick days
• Paid holidays
• Mileage
  
  

Employer will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.

Company Description

As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.

As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.