Insurance Authorization Coordinator

Location: Raleigh, North Carolina - Midtown Pain and Spine Clinic

Reports to: Practice Manager, Midtown Pain and Spine Clinic

Schedule : Monday through Thursday 8:00AM-5:00PM, Friday 8:00AM-2:00PM

The Insurance Authorization Coordinator is responsible for ensuring all procedures, diagnostic imaging orders and injectable medications are properly authorized with the insurance carrier prior to the patient’s appointment.

The Insurance Authorization Coordinator will verify insurance coverage and benefits for scheduled procedures and inform the patient of their estimated out of pocket expense.

• Complete pre-certification of procedures such as facet blocks, epidural injections, radiofrequency ablations, and spinal cord stimulators.
• Complete pre-certification of diagnostic imaging orders such as MRI and CT.
• Complete pre-certification of office administered injectable medication such as Botox and Xeomin. Coordinate deliveries with the specialty pharmacy.
• Review the procedure or test order and discuss with the provider any necessary information to approve and schedule appropriately.
• Document authorization information in the computer systems as required.
• Provide instructions to patients for their scheduled procedures.
• Work closely with providers to ensure procedures are scheduled correctly and in a timely manner. Communicate any changes as appropriate.
• Monitor the physician’s schedule for any added procedures or changes.
• Verify insurance eligibility and benefits for scheduled procedures and inform the patient of their estimated out of pocket expense.
• Achieve expert level knowledge of insurance authorization requirements for procedures and inform providers of any policy changes.
• Ability to read and comprehend medical documentation and apply to insurance requirements for authorization.
• Keep patients informed of authorization status.
• Schedule peer to peer reviews for denied procedures.
• Utilize independent judgment in planning, prioritizing and organizing workload.
• Maintain a pleasant and cooperative demeanor while performing all duties.
• Maintain an open line of professional communication with co-workers and providers regarding patient needs.
• Optimize patients’ satisfaction and providers’ time by following appointment scheduling guidelines.
• Follow HIPAA guidelines for protecting the confidentiality of patient information.
• Maintain operations by following policies and procedures.
• Perform other duties as assigned.

• High school diploma/GED or equivalent previous experience.
• One to two years’ experience in medical authorizations, billing, or test scheduling is preferred.

• Demonstrate excellent customer service skills, as well as the ability to prioritize job duties and multi-task.
• Knowledge of deductibles and coinsurance.
• Ability to handle high patient volumes in a professional manner.
• Ability to maintain composure in stressful situations.

• Work performed in an office environment.
• Involves frequent contact with patients, physicians, and medical office staff.

Competitive salary based on experience.

Health, dental, and vision insurance.

Paid time off and holidays.

Retirement plan options.

Professional development and training opportunities.

ECAA is an equal opportunity employer and does not discriminate against any applicant or employee on the basis of age, race, color, religion, sex, national origin, genetic information, disability, or other legally protected status.

This policy extends to all terms, conditions, and privileges of employment, as well as the use of the Company's facilities and participation in all activities sponsored by the Company.

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