Prior Authorization Coordinator (Project Base)

Core Responsibilities: • Manage end-to-end prior authorizations, insurance verifications, and pre-op documentation for 4 assigned providers • Submit prior authorization requests for MAC and light anesthesia procedures accurately and promptly • Verify patient eligibility, coverage, and COB across commercial payers, Medicare, Medicaid, HMOs, PPOs, Workers' Comp, and MVA • Gather clinical documentation and diagnostic imaging to satisfy medical necessity criteria • Schedule procedure cases in eCW to maintain adequate anesthesia day coverage across all 4 providers • Coordinate post-operative appointments only for the internal provider; omit post-op scheduling for the 3 outside providers who handle their own follow-ups • Maintain compliance with U.S. HIPAA guidelines and PHI protocols Non-Negotiable: • Familiarity with insurance verification, benefits, and payer processes • Strong attention to detail and accuracy • Experience in healthcare accounts and prior authorization submissions, especially for surgical cases • Experience checking eligibility, coordination of benefits (COB), deductible, and coinsurance Required: • Prior healthcare-related administrative experience, ideally in prior authorization or surgical scheduling • Experience with electronic medical records (EMR/EHR); familiarity with eClinicalWorks (eCW) is a strong advantage • Ability to compile and submit clinical documentation to satisfy medical necessity criteria • Working knowledge of CPT/ICD-10 coding as it relates to PA submissions • Ability to manage multiple provider accounts and a high-volume pipeline while consistently meeting daily quotas • Dependability and punctuality, particularly for the assigned overnight shift • Ability to maintain confidentiality and handle protected patient information appropriately Preferred / Advantage: • Prior experience with MAC and light anesthesia surgical procedure authorizations • Prior experience in a pain management or specialty surgical scheduling setting