What are the responsibilities and job description for the AUTHORIZATION COORDINATOR position at Sentara?
Sentara Health is hiring an Authorization Coordinator !
This is a full-time remote position available only to candidates residing in Virginia.
Responsible for review of the clinical information received from physicians, department queues and other clinical providers, ensuring clinical data is substantial enough to authorize services for both 1 time visit account types and recurring accounts. Analyzes clinical information to ensure the services requested are authorized according to clinical and payer protocols. Responsible for insurance verification, member benefits, obtaining authorizations and pre-registration for the services requested. Validates accuracy of insurance enrollment information in the system prior to authorizing services, making certain policy is active. Requires knowledge of managed care contracting, clinical protocols and clinical review requirements. Requires knowledge of regulatory and compliance requirements, for both government and commercial payers. Ensures appropriate and accurate information is entered into systems for processing of patient care and reimbursement. Acts as a liaison between patients, physicians, clinical department and insurance companies.
Job Requirements
- High School Grad or Equivalent
- Related Associate level degree preferred
- Licensed Practical Nurse (LPN) - Nursing License - Compact/Multi-State License – required
- 3 years - Related clinical experience as an LPN in acute Care, managed care or clinic setting.
- Familiar with NCQA standards and turnaround times for prior authorizations.
- Familiarity with MCG and InterQual clinical decision support tools for prior authorizations and utilization review
Sentara Overview:
For more than a decade, Modern Healthcare magazine has ranked Sentara Health as one of the nation's top integrated healthcare systems. That's because we are dedicated to growth, innovation, and patient safety at more than 300 sites of care in Virginia and northeastern North Carolina, including 12 acute care hospitals.
Sentara Benefits
Sentara Health offers employees comprehensive health & welfare and retirement benefits (401(k)/403(b) with employer match) designed with you and your family's well-being in mind. You have a variety of options for medical, dental and vision insurance, life insurance, disability, educational assistance, student loan repayment and voluntary benefits as well as Paid Time Off in the form of sick time, vacation time and paid parental leave.
Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve!
keywords: registration, billing, authorizations, health insurance
Salary : $1,000 - $1,000,000
