Job Description

The Staff Pad has partnered with a hospital in Las Vegas, New Mexico to find a dedicated Prior Authorization & Denials Coordinator to join their team.

Position Summary

The Prior Authorization & Denials Coordinator is responsible for managing prior authorizations for medical services, procedures, and medications, as well as overseeing denied claims to ensure timely reimbursement. This role serves as a liaison between healthcare providers, insurance companies, and patients—helping to ensure that authorization requirements are met and denials are resolved efficiently.

Key Responsibilities

Prior Authorizations

• Obtain prior authorizations for outpatient procedures, diagnostic testing, and specialty medications

• Verify insurance eligibility, benefits, and authorization requirements for scheduled services

• Communicate with insurance companies, physician offices, and patients to secure required documentation

• Track pending authorizations and follow up to ensure timely approvals

Denials Management

• Review and analyze denied claims to determine root causes and appeal opportunities

• Prepare and submit appeals with appropriate documentation and clinical justification

• Collaborate with billing, coding, and clinical teams to gather necessary information for appeals

• Track status and outcomes of appeals, maintaining organized records

• Maintain strict confidentiality of all patient and financial information

Communication & Coordination

• Provide updates to providers, staff, and patients regarding authorization and denial statuses

• Educate internal teams on authorization and denial best practices

• Serve as a subject matter expert for payer-specific policies and insurance guidelines

Compliance & Reporting

• Ensure compliance with payer policies, HIPAA, and regulatory standards

• Maintain accurate records and logs for audits and quality assurance

• Generate regular reports on authorization status, denial trends, and appeal outcomes

Qualifications

Education & Experience

• High school diploma or equivalent required; Associate’s or Bachelor’s degree preferred

• Minimum of 2 years of experience in healthcare billing, utilization management, or a medical office setting

• Prior experience with authorization and denial management is strongly preferred

Skills & Competencies

• Knowledge of insurance carriers, medical terminology, and coding (CPT, ICD-10)

• Excellent organizational and multitasking skills

• Strong written and verbal communication abilities

• Proficient in EHR systems, practice management software, and Microsoft Office

• Detail-oriented with strong problem-solving and analytical skills
  

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