Healthcare Utilization/Authorization Coordinator

Full-time - Entry Level

Baltimore, MD

About the position

The Healthcare Utilization/Authorization Coordinator plays a crucial role in supporting the Utilization Management clinical teams by handling various non-clinical administrative tasks. This position is essential for ensuring that the processes related to pre-service, utilization review, care coordination, and quality of care are executed efficiently. The coordinator will be responsible for a range of administrative support functions that directly impact the quality of service provided to members and providers alike. In this role, the coordinator will spend a significant portion of their time performing member or provider-related administrative support. This includes tasks such as benefit verification, authorization creation and management, and handling claims inquiries. The coordinator will also be tasked with documenting cases accurately to ensure that all necessary information is readily available for review and decision-making. Another key responsibility of the coordinator is to review authorization requests for initial determinations. This involves triaging requests for clinical review and resolution, ensuring that all requests are handled promptly and accurately. The coordinator will also provide general support and coordination services for the department, which includes answering and responding to telephone calls, taking messages, and managing correspondence. This role requires a proactive approach to problem-solving and the ability to research information effectively. Additionally, the coordinator will assist with reporting and data tracking, which includes gathering, organizing, and disseminating information related to the Continuity of Care process and tracking Peer to Peer reviews. This position is primarily remote but may require occasional onsite presence at the client's office in Baltimore, MD. Candidates residing in the DMV area (DC, MD, VA) or Pennsylvania are preferred for this role.

Responsibilities

• Performs member or provider related administrative support including benefit verification, authorization creation and management, claims inquiries and case documentation.
• Reviews authorization requests for initial determination and/or triages for clinical review and resolution.
• Provides general support and coordination services for the department including answering and responding to telephone calls, taking messages, letters and correspondence, researching information and assisting in solving problems.
• Assists with reporting, data tracking, gathering, organization and dissemination of information such as Continuity of Care process and tracking of Peer to Peer reviews.

Requirements

• High School Diploma required.
• Minimum 2 years experience in healthcare claims/service areas, open to either provider or payor sides.
• Experience working with claim authorizations and inputting authorizations into systems.
• Knowledge of CPT and ICD-10 coding is required.
• Previous inbound call center experience.
• Strong data entry skills and data analysis skills for proper code matching.
• Strong MS Outlook skills.

Benefits

• Remote work flexibility with occasional onsite requirements.
• Possibility of contract extension beyond 12 months.