The Staff Pad
Position Summary
The Prior Authorization & Denials Coordinator is responsible for managing prior authorizations for medical services, procedures, and medications, as well as overseeing denied claims to ensure timely reimbursement. This role serves as a liaison between healthcare providers, insurance companies, and patients—helping to ensure that authorization requirements are met and denials are resolved efficiently. Key Responsibilities
Prior Authorizations
Obtain prior authorizations for outpatient procedures, diagnostic testing, and specialty medications Verify insurance eligibility, benefits, and authorization requirements for scheduled services Communicate with insurance companies, physician offices, and patients to secure required documentation Track pending authorizations and follow up to ensure timely approvals Denials Management
Review and analyze denied claims to determine root causes and appeal opportunities Prepare and submit appeals with appropriate documentation and clinical justification Collaborate with billing, coding, and clinical teams to gather necessary information for appeals Track status and outcomes of appeals, maintaining organized records Maintain strict confidentiality of all patient and financial information Communication & Coordination
Provide updates to providers, staff, and patients regarding authorization and denial statuses Educate internal teams on authorization and denial best practices Serve as a subject matter expert for payer‑specific policies and insurance guidelines Compliance & Reporting
Ensure compliance with payer policies, HIPAA, and regulatory standards Maintain accurate records and logs for audits and quality assurance Generate regular reports on authorization status, denial trends, and appeal outcomes Qualifications
Education & Experience
High school diploma or equivalent required; Associate’s or Bachelor’s degree preferred Minimum of 2 years of experience in healthcare billing, utilization management, or a medical office setting Prior experience with authorization and denial management is strongly preferred Skills & Competencies
Knowledge of insurance carriers, medical terminology, and coding (CPT, ICD‑10) Excellent organizational and multitasking skills Strong written and verbal communication abilities Proficient in EHR systems, practice management software, and Microsoft Office Detail-oriented with strong problem-solving and analytical skills
#J-18808-Ljbffr
The Prior Authorization & Denials Coordinator is responsible for managing prior authorizations for medical services, procedures, and medications, as well as overseeing denied claims to ensure timely reimbursement. This role serves as a liaison between healthcare providers, insurance companies, and patients—helping to ensure that authorization requirements are met and denials are resolved efficiently. Key Responsibilities
Prior Authorizations
Obtain prior authorizations for outpatient procedures, diagnostic testing, and specialty medications Verify insurance eligibility, benefits, and authorization requirements for scheduled services Communicate with insurance companies, physician offices, and patients to secure required documentation Track pending authorizations and follow up to ensure timely approvals Denials Management
Review and analyze denied claims to determine root causes and appeal opportunities Prepare and submit appeals with appropriate documentation and clinical justification Collaborate with billing, coding, and clinical teams to gather necessary information for appeals Track status and outcomes of appeals, maintaining organized records Maintain strict confidentiality of all patient and financial information Communication & Coordination
Provide updates to providers, staff, and patients regarding authorization and denial statuses Educate internal teams on authorization and denial best practices Serve as a subject matter expert for payer‑specific policies and insurance guidelines Compliance & Reporting
Ensure compliance with payer policies, HIPAA, and regulatory standards Maintain accurate records and logs for audits and quality assurance Generate regular reports on authorization status, denial trends, and appeal outcomes Qualifications
Education & Experience
High school diploma or equivalent required; Associate’s or Bachelor’s degree preferred Minimum of 2 years of experience in healthcare billing, utilization management, or a medical office setting Prior experience with authorization and denial management is strongly preferred Skills & Competencies
Knowledge of insurance carriers, medical terminology, and coding (CPT, ICD‑10) Excellent organizational and multitasking skills Strong written and verbal communication abilities Proficient in EHR systems, practice management software, and Microsoft Office Detail-oriented with strong problem-solving and analytical skills
#J-18808-Ljbffr