Job Description

Description

The Approval Coordinator secures timely insurance pre-authorizations and approvals for outpatient clinical services. This role minimizes financial risk and prevents claim denials by verifying insurance benefits and accurately mapping medical codes.

Key Responsibilities

• Pre-Authorization: Submit, track, and secure insurance approvals for outpatient procedures, diagnostics, and consultations.
• Code Verification: Review medical documentation to ensure clinical codes align with insurance payer guidelines.
• Payer Communication: Act as the primary liaison between the clinic and insurance providers to resolve authorization discrepancies.
• Denial Prevention: Identify potential approval bottlenecks and proactively appeal administrative pre-authorization denials.
• Patient Support: Inform clinical staff and patients regarding insurance coverage limits and out-of-pocket expectations.
• Data Management: Maintain precise records of all approvals, references, and insurance correspondence in the EHR system.

Requirements

Job Requirements

• Education: Diploma or Bachelor’s degree in Healthcare Administration, Finance, or a related field.
• Certification: Mandatory active CPC (AAPC) or CCS (AHIMA) credential.
• Experience: Minimum of 4 years of continuous experience in an outpatient clinic setting dealing with medical approvals.
• Technical Skills: Proficiency with Electronic Health Records (EHR) and clearinghouse software.
• Knowledge: Deep understanding of CPT, ICD-10-CM coding, and managed care insurance plans.