University Physicians' Association, Inc. (UPA)
Prior Authorization Coordinator
University Physicians' Association, Inc. (UPA), Knoxville, Tennessee, United States, 37955
The
Prior Authorization Coordinator
serves as a liaison between medical providers, insurance companies (payors), and patients. Their primary function is to secure approval from insurance carriers for medical procedures, medications, or treatments before they are administered, ensuring both clinical necessity and financial coverage.
Location:
Knoxville, TN – GI for Kids Job Type:
Full-Time
Why You’ll Love This Role
No nights, no weekends, no on-call
Monday–Friday, standard business hours
Office closed on major holidays
Full benefits package (Medical, Dental, Vision, PTO, 401k with match, and more!)
Core Responsibilities
Insurance Verification: Confirm patient eligibility and benefit coverage details, including co-pays and deductibles, prior to services.
Request Submission: Prepare and submit detailed authorization requests through payer portals, fax, or phone, ensuring all required clinical documentation and diagnosis/procedure codes (ICD-10, CPT) are included.
Status Tracking: Monitor pending requests and follow up with insurance companies to ensure timely approvals and prevent delays in patient care.
Denial Management & Appeals: Review reasons for denied authorizations and initiate the appeals process by gathering additional medical records or coordinating peer-to-peer reviews between physicians and insurance medical directors.
Provider & Patient Communication: Update clinical staff on authorization status and educate patients on their insurance requirements and potential financial responsibilities.
Record Maintenance: Enter and update authorization numbers and expiration dates into Electronic Health Record (EHR) or Practice Management systems for accurate billing.
Key Requirements & Qualifications
Education: Typically requires a High School Diploma or GED; however, many employers prefer an associate or bachelor’s degree in healthcare administration or a related field.
Experience: 1–3 years of experience in medical billing, insurance verification, or a clinical office setting.
Clinical Knowledge: Proficiency in medical terminology, anatomy, and standard coding (ICD-10, CPT, HCPCS).
Technical Skills: Expertise in using insurance portals (e.g., Availity, CoverMyMeds) and EHR systems.
Essential Skills
Detail‑Oriented: Precision in documenting clinical data to minimize the risk of claim denials.
Time Management: Ability to prioritize urgent authorization requests, especially for time‑sensitive treatments like oncology or surgery.
Problem‑Solving: Identify missing information in medical charts and navigate complex, changing insurance policies.
Communication: Professional verbal and written skills for negotiating with insurance adjusters and explaining complex processes to stressed patients.
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Prior Authorization Coordinator
serves as a liaison between medical providers, insurance companies (payors), and patients. Their primary function is to secure approval from insurance carriers for medical procedures, medications, or treatments before they are administered, ensuring both clinical necessity and financial coverage.
Location:
Knoxville, TN – GI for Kids Job Type:
Full-Time
Why You’ll Love This Role
No nights, no weekends, no on-call
Monday–Friday, standard business hours
Office closed on major holidays
Full benefits package (Medical, Dental, Vision, PTO, 401k with match, and more!)
Core Responsibilities
Insurance Verification: Confirm patient eligibility and benefit coverage details, including co-pays and deductibles, prior to services.
Request Submission: Prepare and submit detailed authorization requests through payer portals, fax, or phone, ensuring all required clinical documentation and diagnosis/procedure codes (ICD-10, CPT) are included.
Status Tracking: Monitor pending requests and follow up with insurance companies to ensure timely approvals and prevent delays in patient care.
Denial Management & Appeals: Review reasons for denied authorizations and initiate the appeals process by gathering additional medical records or coordinating peer-to-peer reviews between physicians and insurance medical directors.
Provider & Patient Communication: Update clinical staff on authorization status and educate patients on their insurance requirements and potential financial responsibilities.
Record Maintenance: Enter and update authorization numbers and expiration dates into Electronic Health Record (EHR) or Practice Management systems for accurate billing.
Key Requirements & Qualifications
Education: Typically requires a High School Diploma or GED; however, many employers prefer an associate or bachelor’s degree in healthcare administration or a related field.
Experience: 1–3 years of experience in medical billing, insurance verification, or a clinical office setting.
Clinical Knowledge: Proficiency in medical terminology, anatomy, and standard coding (ICD-10, CPT, HCPCS).
Technical Skills: Expertise in using insurance portals (e.g., Availity, CoverMyMeds) and EHR systems.
Essential Skills
Detail‑Oriented: Precision in documenting clinical data to minimize the risk of claim denials.
Time Management: Ability to prioritize urgent authorization requests, especially for time‑sensitive treatments like oncology or surgery.
Problem‑Solving: Identify missing information in medical charts and navigate complex, changing insurance policies.
Communication: Professional verbal and written skills for negotiating with insurance adjusters and explaining complex processes to stressed patients.
#J-18808-Ljbffr