Insurance Authorization Coordinator

• Receives phone calls and faxed referral requests from providers.

• Verifies member eligibility and benefits.

• Inputs all referral requests including ICD-9 and CPT codes into system accurately for electronically generated authorization tracking.

• Provides referral authorization to external providers per UM Departmental Policy and Procedures and specific contracted Client's process.

• Requests submission of appropriate medical records according to established criteria for requested service(s).

• Issues authorization within appropriate timeframe for routine, urgent and emergent requests.

• Appropriately forwards all referral requests to the next level of review.

• Coordinates approved outpatient surgical procedures in specialist's office and/or outpatient surgical facilities with health plan's authorization department when applicable.

• Coordinates approved services with Home Health Providers, Plan discharge Planners and Plan Members as delegated or required by Plan.

• Is resource person for PCP to refer to network specialist(s).

• Compiles monthly departmental statistics.

• Distributes correspondence and other information to the appropriate parties or departments.

• Maintains appropriate logs, records, and reports as established by Utilization Department.

• Identifies providers who are problematic with plan requirements.