[Hiring] Authorization Coordinator @COPE Health Solutions
Role Description
The Authorization Coordinator works under general supervision and plays a key role in maintaining efficient UM operations, ensuring regulatory compliance, and supporting high-quality member service.
Key Responsibilities
ā¢ Creates and modifies authorizations and/or orders for new and existing Members in an accurate and timely manner.
ā¢ Researches, troubleshoots, resolves authorization and/or order processing issues and discrepancies.
ā¢ Completes activities, including but not limited to, inbound/outbound calls, as assigned, faxes, and emails.
ā¢ Obtains information from internal and external sources. Processes or triages the request via our medical management information system or external sources.
ā¢ Coordinates with Providers and Members regarding authorization requests and/or activities.
ā¢ Communicates with Care Management, Member Services, Membership and Eligibility, and other internal departments regarding Member services, authorization requests, and issues.
ā¢ Reviews all authorization requests for accuracy and prioritizes based on urgency.
ā¢ Documents communication, actions taken, and barriers in the Medical Management System as it pertains to the Members Care or request for services.
ā¢ Utilizes internal and external systems to verify eligibility and Provider Information such as name, address, fax number, NPI, and TAX ID.
ā¢ Conducts follow-up, as necessary, to ensure member satisfaction and successful delivery of service.
ā¢ Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
ā¢ Participates in special projects and performs other duties as required.
Core Competencies
ā¢ Attention to detail and accuracy.
ā¢ Customer and provider service orientation.
ā¢ Ability to work in a fast-paced, high-volume environment.
ā¢ Critical thinking and problem-solving skills.
ā¢ Collaboration and cross-functional teamwork.
ā¢ Time management and prioritization.
ā¢ Adaptability and continuous improvement mindset.
Qualifications
ā¢ 2ā3 years of experience in healthcare customer service, authorization processing, or utilization management.
ā¢ Experience working in a Managed Care or Health Plan environment.
ā¢ Familiarity with prior authorization workflows.
ā¢ Strong written and verbal communication skills.
ā¢ Prior experience in Utilization Management intake or prior authorization within a health plan.
Benefits
ā¢ Comprehensive, affordable insurance plans for team members and their families.
ā¢ Yearly stipend for wellness-related activities.
ā¢ Paid parental leave program.
Company Description
COPE Health Solutions is a national tech-enabled services firm powering success for health plans and for providers in risk arrangements. Our comprehensive NCQA certified population health management platform and highly experienced team brings deep expertise, experience, proven tools, and processes to improve financial performance and quality outcomes for all types of payers and providers.
For more information, visit
COPE Health Solutions
.
To Apply
To apply for this position or for more information about COPE Health Solutions, visit us at
COPE Health Solutions Careers
.
Apply tot his job
Apply To this Job
The Authorization Coordinator works under general supervision and plays a key role in maintaining efficient UM operations, ensuring regulatory compliance, and supporting high-quality member service.
Key Responsibilities
ā¢ Creates and modifies authorizations and/or orders for new and existing Members in an accurate and timely manner.
ā¢ Researches, troubleshoots, resolves authorization and/or order processing issues and discrepancies.
ā¢ Completes activities, including but not limited to, inbound/outbound calls, as assigned, faxes, and emails.
ā¢ Obtains information from internal and external sources. Processes or triages the request via our medical management information system or external sources.
ā¢ Coordinates with Providers and Members regarding authorization requests and/or activities.
ā¢ Communicates with Care Management, Member Services, Membership and Eligibility, and other internal departments regarding Member services, authorization requests, and issues.
ā¢ Reviews all authorization requests for accuracy and prioritizes based on urgency.
ā¢ Documents communication, actions taken, and barriers in the Medical Management System as it pertains to the Members Care or request for services.
ā¢ Utilizes internal and external systems to verify eligibility and Provider Information such as name, address, fax number, NPI, and TAX ID.
ā¢ Conducts follow-up, as necessary, to ensure member satisfaction and successful delivery of service.
ā¢ Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
ā¢ Participates in special projects and performs other duties as required.
Core Competencies
ā¢ Attention to detail and accuracy.
ā¢ Customer and provider service orientation.
ā¢ Ability to work in a fast-paced, high-volume environment.
ā¢ Critical thinking and problem-solving skills.
ā¢ Collaboration and cross-functional teamwork.
ā¢ Time management and prioritization.
ā¢ Adaptability and continuous improvement mindset.
Qualifications
ā¢ 2ā3 years of experience in healthcare customer service, authorization processing, or utilization management.
ā¢ Experience working in a Managed Care or Health Plan environment.
ā¢ Familiarity with prior authorization workflows.
ā¢ Strong written and verbal communication skills.
ā¢ Prior experience in Utilization Management intake or prior authorization within a health plan.
Benefits
ā¢ Comprehensive, affordable insurance plans for team members and their families.
ā¢ Yearly stipend for wellness-related activities.
ā¢ Paid parental leave program.
Company Description
COPE Health Solutions is a national tech-enabled services firm powering success for health plans and for providers in risk arrangements. Our comprehensive NCQA certified population health management platform and highly experienced team brings deep expertise, experience, proven tools, and processes to improve financial performance and quality outcomes for all types of payers and providers.
For more information, visit
COPE Health Solutions
.
To Apply
To apply for this position or for more information about COPE Health Solutions, visit us at
COPE Health Solutions Careers
.
Apply tot his job
Apply To this Job