Prior Authorization Coordinator

Verification and Authorization Tea ---------- mber primary duties include verifying insurance eligibility; determining deductible, copay, and prior balances to be collected; updating insurance when necessary. Verification and Authorization coordinators are also responsible for obtaining authorizations, referrals, pre-determinations, or any other payer pre-service approval as needed.

• Verify eligibility as active for add-on appointments, staying ahead of schedule, and verifying eligibility the same day for services scheduled and performed on the same day.
• Utilize payer websites for further verification when needed.
• Validate that the correct plan was chosen per the insurance guide and provide feedback to the supervisor for feedback to upstream areas
• Confirm network participation and advise patients of our provider’s network participation when needed.
• Forward new plans to supervisor for payer file updates.
• Document verification activities in the system to support productivity and quality tracking.
• Copay, deductible, and prior balance verification
• Notate copays, deductibles, and prior balances to be collected.
• Ensure the system is updated.
• Obtaining required referrals and authorizations prior to services via phone, fax, online, etc.
• Review Office Schedules daily for patients requiring authorizations, referrals, and insurance verification.
• Obtaining retro authorizations in a timely manner.