Authorization Coordinator

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

📋 Description

• Evaluate clinical data provided by physicians and other healthcare professionals.

• Confirm that clinical information is adequate to authorize necessary services.

• Assess clinical details to ensure that requested services comply with clinical protocols for authorization.

• Verify member benefits for the services being requested.

• Check insurance enrollment details in the system prior to service authorization.

• Accurately input relevant data into the claims system for processing payments.

⛳️ Requirements

• High School Diploma (mandatory).

• Licensed Practical Nurse – LPN (mandatory).

• A minimum of 3 years of pertinent experience (mandatory).

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

• Familiarity with managed care contracts, clinical protocols, and clinical review standards.

• Understanding of regulatory and compliance guidelines for government payers, self-funded, and commercial insurers.

• Experience in Utilization Management (preferred).

• Background in Diagnostic Imaging (preferred).

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

• Experience with Milliman software (preferred).

🏝️ Benefits

• Medical, Dental, and Vision insurance options.

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

• Paid Time Off and Sick Leave.

• Paid Parental and Family Caregiver Leave.

• Emergency Backup Care services.

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

• Life Insurance coverage.

• 401k/403B plans with Employer Matching contributions.

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

• Student Debt Pay Down assistance of $10,000.

• Pet Insurance options.

• Access to Legal Resources Plan.

• Potential to earn an annual discretionary bonus if the established criteria for the system and employee eligibility are met.