
Clinical Authorization Coordinator
1 day ago
We are seeking a skilled professional to support our prior authorization process as a Prior Authorization Specialist.
Job DescriptionThis role involves applying clinical knowledge to review, evaluate, and process medical service requests to ensure they meet payer requirements. The ideal candidate will have a strong understanding of medical terminology and payer guidelines, as well as experience in utilization management or authorization processes.
Key Responsibilities- Review prior authorization requests for medical services, procedures, and prescriptions.
- Apply clinical knowledge and payer guidelines to assess medical necessity.
- Ensure compliance with regulatory requirements such as HIPAA, CMS, and insurance regulations.
- Coordinate with healthcare providers to obtain additional documentation.
- Maintain accurate case records in electronic health record systems.
- Bachelor's degree in Nursing, Pharmacy, Allied Health, or equivalent clinical field.
- Knowledge of ICD-10, CPT, and HCPCS coding systems.
- Prior experience in utilization management or authorization processes is highly preferred.
- Excellent communication and detail-oriented problem-solving skills.
- Absenteeism is greatly reduced due to the work-from-home arrangements for this position.
- Entry level
- Full-time
- Health Care Provider
- Medical Services
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