Pre-Authorization Coordinator - Licensed Practical Nurse

Location
Virginia Beach, VA
Salary
Competitive
Posted
Jun 14, 2019
Closes
Jul 09, 2019
Ref
125269BR
Function
Nurse
Industry
Healthcare
Hours
Full Time
Responsible for review of clinical information received from Physicians and other Clinical providers ensuring clinical data is substantial enough to authorize services. Analyzes clinical information to ensure the services requested are authorized according to clinical protocols. Responsible for validation of member benefits for the services requested. Validates accuracy of insurance enrollment information in the system prior to authorizing services. Requires knowledge of managed care contracting, clinical protocols and clinical review requirements. Requires knowledge of regulatory and compliance requirements for government payers, self funded and commercial payers. Ensures appropriate and accurate information is entered into claims system for processing of payment.

Qualifications

Education Level
Trade School Graduate

Experience
Required: Related - 3 years

Preferred: None, unless noted in the "Other" section below

License
None, unless noted in the "Other" section below

Skills
None, unless noted in the "Other" section below

Other
Related clinical experience as a Medical Assistant or LPN experience in a physician office, acute care, managed care or clinic setting. Active license required as applicable.

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