Fort Lauderdale, FL
- Job Level:
$14.00 - $16.00/hr.
We are currently looking for an Authorization Coordinator to fulfill an opening we have in Fort Lauderdale, FL. As the Authorization Coordinator, you would be responsible for servicing the needs of members, providers, and the Health Plans representatives, by effectively handling referrals from providers to facilitate the clinical review, issue authorizations and coordination of referrals services utilizing pre-approved screening criteria in compliance with contracted Client's requirements and adopted clinical guidelines. Handles the more complex requests for treatment and authorization requests. Conducts searches on authorization requests to handle complex Provider inquiries.
Our client is a medical management organization, which delivers a portfolio of integrated services. The company is located in Fort Lauderdale, FL and has been in the business for over twenty years. As a motto, their market leadership position is of the utmost importance.
- Receives referral requests from providers and Health Plans representatives.
- Assist in processing medical services request.
- Completes clerical duties related to the processing of Authorization Requests and Provider Referrals.
- Verifies member’s eligibility and benefits with subsequent notification to designated staff of eligibility issues.
- Inputs all requests for services received via fax or phone into the system accurately for electronically generated authorization and tracking.
- Provides services authorizations to providers per UM Departmental Policy and Procedures and specific contracted Client's process in a timely manner.
- Requests submission of appropriate medical records according to established criteria for requested service(s) in accordance with the corresponding Policy and Procedure.
- Notifies required parties within the appropriate timeframe for routine and urgent requests for services.
- Researches member history for duplications and consideration of authorization limits.
- Verifies fax numbers and system updates.
- Communicates with requesting provider for any identified need to clarify a request for an authorization, such as CPT codes, ICD10, requested timeframes and member’s demographics.
- Provides effective departmental communication with both internal and external sources.
- Forwards Authorizations to appropriate department staff in terms of eligibility and other coverage, pricing, and benefits issues.
- Scans, attaches, reviews and effectively works with electronic images as part of the authorization process. Including recording the required information from attachments into the authorization fields.
- Collaborates with Supervisor, Network, and Claims Department Staff to resolve complex authorization issues.
- Appropriately forwards all referral requests to the next level of clinical review as applicable and after verifying for completeness and appropriateness.
- High school diploma or general education degree (GED).
Experience & Skills Required
- Medical coding or authorization education/train.
- At least six months experience in a prior, similar position.
- Bilingual English/Spanish.