Insurance Authorization Coordinator

• Receives phone calls and faxed referral requests from providers.
• Verifies member eligibility and benefits.
• Inputs all referral requests including ICD-9 and CPT codes into system accurately for electronically generated authorization tracking.
• Provides referral authorization to external providers per UM Departmental Policy and Procedures and specific contracted Client's process.
• Requests submission of appropriate medical records according to established criteria for requested service(s).
• Issues authorization within appropriate timeframe for routine, urgent and emergent requests.
• Appropriately forwards all referral requests to the next level of review.
• Coordinates approved outpatient surgical procedures in specialist's office and/or outpatient surgical facilities with health plan's authorization department when applicable.
• Coordinates approved services with Home Health Providers, Plan discharge Planners and Plan Members as delegated or required by Plan.
• Is resource person for PCP to refer to network specialist(s).
• Compiles monthly departmental statistics.
• Distributes correspondence and other information to the appropriate parties or departments.
• Maintains appropriate logs, records, and reports as established by Utilization Department.
• Identifies providers who are problematic with plan requirements.

• High school diploma or general education degree (GED)

• At least 2-3 years with insurance authorization and referrals

INTERESTED IN BEING CONSIDERED? Take the next step! Click on the green I'M INTERESTED button to submit your resume for review. Or send your resume to Jessica Mac Donell directly at jmacdonell@healthcaresupport. com or call 407-478-0332 x140

All your information will be kept confidential according to EEO guidelines.