AUTHORIZATION COORDINATOR

City/State

Overview

Work Shift

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.

SentaraBenefits

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-beingin 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

Job Summary

Qualifications:

Skills

Sentara Healthcare 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.

Per Clinical Laboratory Improvement Amendments (CLIA), some clinical environments require proof of education; these regulations are posted at ecfr.gov for further information. In an effort to expedite this verification requirement, we encourage you to upload your diploma or transcript at time of application.

In support of our mission "to improve health every day," this is a tobacco-free environment.