Prior Authorization Coordinator (Project Base)

Core Responsibilities:

• Manage end-to-end prior authorizations, insurance verifications, and pre-op documentation for 4 assigned providers
• Submit prior authorization requests for MAC and light anesthesia procedures accurately and promptly
• Verify patient eligibility, coverage, and COB across commercial payers, Medicare, Medicaid, HMOs, PPOs, Workers' Comp, and MVA
• Gather clinical documentation and diagnostic imaging to satisfy medical necessity criteria
• Schedule procedure cases in eCW to maintain adequate anesthesia day coverage across all 4 providers
• Coordinate post-operative appointments only for the internal provider; omit post-op scheduling for the 3 outside providers who handle their own follow-ups
• Maintain compliance with U.S. HIPAA guidelines and PHI protocols

Requirements

Non-Negotiable:

• Familiarity with insurance verification, benefits, and payer processes
• Strong attention to detail and accuracy
• Experience in healthcare accounts and prior authorization submissions, especially for surgical cases
• Experience checking eligibility, coordination of benefits (COB), deductible, and coinsurance

Required:

• Prior healthcare-related administrative experience, ideally in prior authorization or surgical scheduling
• Experience with electronic medical records (EMR/EHR);