Authorization Coordinator

This is a fully remote position, open to applicants in Virginia.

📋 Description

• Evaluate clinical information received from healthcare professionals and other clinical sources.

• Ensure that clinical data is adequate to authorize services.

• Assess clinical information to confirm that requested services are authorized in line with clinical protocols.

• Verify member benefits for the requested services.

• Check the accuracy of insurance enrollment details prior to service authorization.

• Input correct and precise information into the claims system for payment processing.

⛳️ Requirements

• High School Diploma (mandatory).

• Licensed Practical Nurse – LPN (mandatory).

• Minimum of 3 years of relevant experience (mandatory).

• Relevant clinical experience as an LPN, such as work in a physician's office, acute care, managed care, or clinic environment.

• Understanding of managed care contracting, clinical protocols, and clinical review standards.

• Familiarity with regulatory and compliance standards for government payers, self-funded plans, and commercial insurers.

• Experience in Utilization Management (preferred).

• Experience in Diagnostic Imaging (preferred).

• Proficiency in Microsoft Suite (Word, Excel, Outlook) (preferred).

• Experience with Milliman (preferred).

🏝️ Benefits

• Medical, Dental, and Vision insurance plans.

• Adoption, Fertility, and Surrogacy Reimbursement up to $10,000.

• Paid Time Off and Sick Leave.

• Paid Parental and Family Caregiver Leave.

• Emergency Backup Care.

• Long-Term, Short-Term Disability, and Critical Illness insurance plans.

• Life Insurance.

• 401k/403B with Employer Matching.

• Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education.

• Student Debt Pay Down – $10,000.

• Pet Insurance.

• Legal Resources Plan.

• Opportunity to qualify for an annual discretionary bonus if established system and employee eligibility criteria are met.