Prior Authorization Coordinator

Mayfield Clinic • Cincinnati, OH

1d

About The Position

Were excited to highlight a key position on our team! This role plays a vital part in ensuring seamless patient care by obtaining prior authorizations from third-party payors for all hospital admissions, outpatient procedures, surgeries, and interventional pain proceduresboth in-office and outpatient. Acting as a liaison between physicians and insurance providers, this position helps streamline the approval process and supports timely, effective treatment for our patients.

Requirements

• High School graduate.
• Minimum of 1 -2 years of experience in a medical secretary/scheduling role or related position
• Practical knowledge of neurosurgical procedures and medical office processes
• Working knowledge of CPT and ICD coding
• Demonstrates excellent customer service
• Ability to manage and prioritize multiple tasks in a fast-paced environment
• Strong problem-solving, problem-prevention, and decision-making skills
• Ability to convey empathy
• Excellent oral and written communication skills
• Ability to maintain composure and restore calm in a stressful situation
• Uses good judgment and diplomacy when dealing with others
• Desire and ability to work in a team environment
• Computer proficient with the ability to learn multiple software applications
• Familiar with insurance company requirements and payor medical policies
• Ability to work with minimal supervision

Responsibilities

• Help develop and maintain a corporate culture that supports the mission and values of Mayfield Clinic.
• Initiate and document prior authorization for all third-party payors for patients undergoing a procedure or hospital admission.
• Adhering to standardized processes for documentation and follow-up.
• Work collaboratively with the surgery scheduler/medical secretary to ensure information is complete and accurate.
• Record all prior authorization phone calls, documents, and authorization numbers in the surgical worksheet.
• Scan or copy/paste online authorizations into the EHR.
• In the event of a claim denial due to prior authorization, provide follow-up and documentation to Revenue Cycle Management to support an appeal.
• Obtain prior authorization and/or schedule testing (eg, MRI, MRA, CT) on an as-needed basis.
• Work in concert with the Revenue Cycle Management Department to reduce and/or minimize third-party payer denials for prior authorizations or pre-determined issues.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED