City/State
Chesapeake, VAWork Shift
First (Days)Overview:
Overview
The Authorization Coordinator I is responsible for securing prior authorizations for patient services while ensuring compliance with payer rules and policies. This role involves collaborating with hospital departments, medical practice staff, providers and patients to facilitate the authorization, retro-authorization, and peer-to-peer process utilizing payer portals and automation tools effectively. The Authorization Coordinator I maintains up-to-date knowledge of insurance plans and regulations and is adept in identifying patient insurance and benefits to streamline the authorization workflow.
Key Responsibilities
Obtain and Verify Authorizations: Request and secure prior authorizations for procedures, diagnostic testing, hospital admissions, and specialty services according to payer requirements.
Insurance Verification: Confirm patient insurance eligibility, benefits, and coverage details to ensure services are authorized appropriately.
Documentation: Accurately record authorization numbers, payer requirements, and status updates in the electronic health record (EHR) or billing system.
Communication: Serve as a liaison between providers, patients, and insurance companies to clarify requirements and resolve authorization issues.
Follow-Up: Track pending authorizations, monitor turnaround times, and escalate delays to prevent service denials or scheduling disruptions.
Denial Prevention: Review payer policies and authorization guidelines to reduce authorization-related claim denials.
Collaboration: Work closely with clinical staff, schedulers, and billing teams to ensure all necessary approvals are obtained prior to service delivery.
Confidentiality & Compliance: Adhere to HIPAA and organizational policies while handling sensitive patient and insurance information.
Other Requirements
Strong attention to detail, organizational skills, and clear communication are essential to success in this role.
Education
High school graduate or equivalent Required)
Certification/Licensure
No specific certification or licensure requirements
Experience
One year of related experience (Required)
Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.
In support of our mission “to improve health every day,” this is a tobacco-free environment.
For positions that are available as remote work, Sentara Health employs associates in the following states:
Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.