Pre Authorization Coordinator

Company: Sentara Healthcare
Location: Norfolk
Posted on: January 11, 2022

Job Description:

720314No51211621112-28-2021Requisition Id159504BRDepartment Number and Name706152326 Government Authorization Job DescriptionResponsible 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.Physical LocationOptima Health - Norfolk Job TitlePre Authorization CoordinatorEmployment StatusFull time ShiftsFirst (Days) Job CategoryAdministrative/Clerical, Health Plan, Optima Health, Talroo-Health PlanCityNorfolk, VA Required EducationHigh School Grad or EquivalentExperienceRequired: Related - 3 yearsPreferred: None, unless noted in the "Other" section belowLicenses and CertificationsRequired: Licensed Practical NursePreferred: None, unless noted in the "Other" section belowSkillsRequired: Preferred: None, unless noted in the "Other" section belowOtherRelated clinical experience as an LPN, such as experience in a physician office, acute care, managed care or clinic setting. Active license required as applicable.Job PostingSentara Health Plan is currently hiring anEmergency Department Technician-Lake Ridge For Optima Health! This is a Full Time position with day shift hours and great benefits!Position is located in Norfolk, VA.Job Requirements:High School Grad or EquivalentRequired: Related - 3 yearsRequired: Licensed Practical NurseRelated clinical experience as an LPN, such as experience in a physician office, acute care, managed care or clinic setting. Active license required as applicable.Sentara Health Plans is the health insurance division of Sentara Healthcare doing business as Optima Health and Virginia Premier. Sentara Health Plans provides health insurance coverage through a full suite of commercial products including consumer-driven, employee-owned and employer-sponsored plans, individual and family health plans, employee assistance plans and plans serving Medicare and Medicaid enrollees.With more than 30 years experience in the insurance business and 20 years experience serving Medicaid populations, we offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services all to help our members improve their health.

Keywords: Sentara Healthcare, Norfolk , Pre Authorization Coordinator, Other , Norfolk, Virginia