Prior Authorization Coordinator

The Prior Authorization Coordinator ensures timely completion of prior authorizations by reviewing patient information, contacting insurance for approval, and maintaining detailed records. They collaborate with schedulers, medical professionals, and billing teams, track authorization status, handle appeals, and generate reports to improve efficiency. Responsibilities include:

• Review information obtained from scheduler for completeness and obtain missing information
• Review available patient information to obtain patient insurance information
• Review practice information to determine if prior authorization is required
• When prior authorization is required or it is unclear from internal documentation if it is required, contact insurance to obtain authorization
• Provide insurance company with any required documentation to obtain the authorization
• Follow up on outstanding requests to ensure all required authorizations are required
• Maintain detailed documentation on prior authorization activities in EHR including:
• Documentation of why authorization is not required if not obtained
• Details of all calls to insurance companies including the name of the insurance contact, date and time of call, reference number, summary of call outcome
• Details of information sent to the insurance company including how the information was sent, date sent, and information included
• Authorization number for the procedure, date obtained, and method for obtaining (website, insurance rep, other)
• Maintain ongoing communication with schedulers regarding status of the prior authorization (pending, approved, not approved, not required)
• If required, set up peer to peer review and provide required information
• On a daily basis, review and prioritize requests for prior authorization to ensure prior authorizations are obtained in a timely and efficient manner
• Update practice information on prior authorization requirements as changes are identified
• Coordinate with Billing on claims denied for lack of prior authorization to provide information to support appeals process
• Assist with surgery scheduling activities if requested
• Attend regular on-site meetings for process collaboration or review the status of ongoing prior authorization requests.
• Attend regular on-site meetings to provide information to support appeals process.
• Generate reporting related to the success rate of prior authorizations, the number of appeals submitted, and other key metrics. These reports will be shared with managers or the healthcare organization to improve efficiency and identify areas for improvement.
• The coordinator works closely with doctors, nurses, and other medical professionals to gather the correct medical documentation for the prior authorization. This may require in-person collaboration with other departments.
• Adhere to policies of Surgical Specialists of Charlotte, OSHA, and HIPAA standards and guidelines.
• Perform strategic and tactical functions to do whatever is required to model outstanding customer service toward our patients, clients and staff.
• Perform other duties as assigned.

Agree to promote and adhere to Surgical Specialists of Charlotte's core values:

• Trust
• Respect
• Integrity
• Clear Communication
• Collaboration