Authorization Coordinator- Pediatric Clinic

Job description

Authorizations Coordinator

DEPARTMENT: Pediatric Clinic

REPORTS TO: Clinic Manager

This document is intended to describe the general duties required for this position. It is not intended to serve as an exhaustive list of duties, skills, and responsibilities.

Summary: The position entails obtaining authorization and utilization reviews for several locations. Responsible for verifying patient-eligibility, coordinating benefits, and facilitating insurance coverage, as well as addressing patients’ concerns regarding authorization and turnaround.

Responsibilities:

· Verify eligibility with all insurances, request authorizations/referrals.

· Contact Primary Care Physicians for required information.

· Follow up with the insurance authorization department to obtain authorizations in a timely manner.

· Create charts and upload all authorizations and referrals.

· Reports to Manager any referrals that have not met the required timeline and monitors daily reports of completed authorizations for quality assurance

· Contact patient by telephone to inform that referral has been approved or denied, and logs the event appropriately within the authorization system. When required on expedited authorizations, also verbally contacts the requesting provider of the approval or denial.

· Enters required data into authorization software accurately.

· Answers questions and educates referring providers on the processes, requirements and documentation required to authorize services that promote quality of care.

· Other duties as assigned.

Qualifications:

• High School Diploma or GED required
• 2 years in a medical office setting
• 2 years of medical authorizations and referral processing
• Knowledge and experience with an EHR, and medical database
• Excellent telephone and communication skills
• Knowledge of CPT codes and different types of insurances (Medi-Cal/HMO/PPO)
• Ability to work quickly and under pressure

WORK ENVIRONMENT:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.

CFHE Core Values

• Commitment to Service – Ensures efficient operations that support quality patient care and resource stewardship.
• Integrity and Accountability – Upholds transparency and compliance in all purchasing and inventory processes.
• Teamwork and Collaboration – Partners effectively with cross-functional teams to achieve organizational goals.
• Respect and Compassion – Supports CFHE’s mission by maintaining professionalism and empathy in all interactions.
• Excellence and Quality – Strives for operational excellence through research-driven, data-informed decisions.