Prior Authorization

The Prior Authorization Coordinator is responsible for verification of benefits and eligibility confirmation for patients, as well as obtaining all pre-authorizations and pre-certifications required for scheduled procedures as necessary and appropriate.  They work closely with carriers and staff to review, research and complete authorization appeals, rectify rejected claims, and notifying patients, procedure schedulers, and the billing department of any services requested and/or referred that are not authorized by insurance.  The Prior Authorization Coordinator will determine patient liability for the services to be provided and notify the patient of his/her financial responsibility. 

Essential Duties and Responsibilities:

• Obtain pre-authorization for all procedures and treatments being provided prior to patient appointments.
• Verify patient insurance information is accurate and documented correctly.
• Investigate, report and analyze patient CPT codes not originally noted in the CPTN at the onset of the pre-authorization process.
• Review and resolve all reported authorization issues timely and effectively.
• Communicate authorization, and any financial and benefit coverage with patients and providers timely and professionally.
• Obtain appropriate documentation to validate the approval or denial of authorizations.
• Maintain patient file security and confidentiality by adhering to appropriate confidentiality and HIPPAA policies and guidelines. 
• Advise management of identified trends with payers in an effort to minimize problems.
• Special projects as assigned.

• High school diploma or equivalent
• Experience in a health care setting required
• ICD-10 and CPT knowledge required
• Proficiency in MS Office
• Comprehensive understanding of authorizations required
• Experience with EPIC gGastro preferred

Gastro Care Partners is the national partner for successful regional gastroenterology practices. We believe in the mantra “medicine is local.” Gastro Care Partners provides high-performing regional practices with the resources necessary to thrive in today’s dynamic healthcare landscape while maintaining their practices’ identities.