Coordinator Prior Authorization

DaVita Medical Group - Albuquerque, NM3.1

Full time Prior Authorization Coordinator Opportunity at our Roma Location

Overview of Position: Prior Authorization Coordinator is responsible for obtaining prior authorizations on all diagnostic testing and procedures scheduled by clinicians of the group. Coordinates and manages the prior authorization process which includes collaborating with various departments, insurance companies and individuals to meet requirements. Adheres to policies, procedures and regulations to ensure compliance and patient safety. Participation in Compliance and other important training is a condition of employment.

Essential Functions:
Collaborates with departments and insurance companies to obtain the necessary prior authorizations for services ordered/scheduled. Maintains a high level and up to date understanding of insurance companies and prior authorization requirements. Verifies and understands insurance benefits
Ensures payer medical policy documentation requirements are met to expedite approval and authorization documentation is scanned and documented in the patient’s medical record and attached to the claim.
Communicates with other prior authorization/referral specialists, schedulers and coders to continually monitor changes in payer medical polices and prior authorization requirements.
Reviews and submits all follow-up authorizations due to reschedules and procedure code changes
Consults and works in partnership with multiple clinicians to review prior authorization denials, obtain additional documentation or set-up peer to peer reviews.
Pre-screens appointment schedules and works 1-2 weeks out with provider schedules along with checking daily add-ons.
Accesses and is familiar with online authorization sites (Availity, eviCore, Qualis, ect) as well handling them via phone.
Responsible for meeting monthly productivity and accuracy goals.
Other duties as assigned.

Required: High School diploma or GED

Required: Two years of related experience

Preferred: Two years’ experience in prior authorization

Knowledge, Skills, Abilities: Excellent communication and customer service skills.

Knowledgeable with medical terminology and CPT and ICD-10 coding.General knowledge of healthcare insurance processes, medical policy and prior authorization requirements. Strong attention to detail with critical thinking skills. Ability to prioritize and multitask.

Preferred: Proficiency in the use of healthcare information systems, online websites and portals.

DaVita Medical Group is one of the nation’s medical groups and is a national medical group with operations in New Mexico, Nevada, Colorado, Florida, California and Washington. It is an exciting time to join DaVita Medical Group NM as we blaze new trails in coordinated care, setting the new standard in New Mexico for compassionate, cost-effective, high quality healthcare.

If you’re looking to make a difference with a large, financially stable, well-recognized medical group, DaVita Medical Group may be the employer for you.

DaVita Medical Group is an equal opportunity/affirmative action employer. As such, DaVita Medical Group makes hiring decisions solely on the basis of qualifications and experience, and without regard to age, race, color, religion, sex, gender identity, sexual orientation, national origin, disability or protected veteran status.

We maintain a drug-free workplace and perform pre-employment substance abuse testing and background verification checks.

DaVita Medical Group will consider qualified applicants who have criminal histories in a manner consistent with the law.