Insurance Authorization Coordinator

At UK St. Claire, our staff is our greatest asset in the mission to create a healthier and more prosperous population. We strive to foster the talent and potential of our employees and prioritize safe working conditions and equal compensation rates to ensure that continual growth is possible. UKSC is a nurturing workplace for all healthcare professionals. We invite you to explore our current job openings and see if our opportunities could be the right fit for you.

Job Description:

Job Summary

Responsible for ensuring accurate and timely insurance authorizations for diagnostic imaging as well as surgical and in clinic procedures. Provides expertise in payer guidelines, coding conventions, and authorization processes to minimize delays and denials. Coordinates with providers, payers, and pre-registration to validate eligibility, and secure approvals. Maintains compliance with institutional, state, and federal regulations while promoting service excellence and operational efficiency.

Essential Functions

• Obtains prior authorizations for diagnostic imaging as well as surgical and in clinic procedures from insurance payers within required timelines.

• Reviews medical records and documentation to determine appropriate clinical information needed for authorization requests.

• Applies knowledge of ICD-10, CPT, and HCPCS coding conventions to support accurate authorization submissions.

• Confirms patient eligibility and coverage through payer portals and systems to ensure service approval.

• Monitors payer guideline updates, and communicates changes to providers and staff.

• Maintains HIPAA compliance and safeguards patient information when handling clinical and financial data.

• Resolves escalated authorization issues by collaborating with providers, payers, and patients to identify alternatives.

• Participates in quality assurance, training, and professional development activities

• Performs other duties as assigned.

Education Requirement: High school diploma or equivalent

Experience Requirement: 2-3 years of experience

An equivalent combination of education and experience may be considered. All experience must be paid and in the same related field. Part-time and PRN experience will be prorated based on hours worked per week. Volunteer work and internships for academic credit are not counted.

Certifications & Licensures: N/A

Working Conditions

A. Lifting, pushing, and/or pulling objects up to 50lbs:2. Occasional (< 10% of the time)

B. Lifting, pushing, and/or pulling objects over 50lbs:1. Never

C. Standing or walking with objects up to 10lbs:3. Intermittent (10% - 50% of the time)

D. Standing or walking with objects up to 25lbs:2. Occasional (< 10% of the time)

E. Sitting at the computer workstation for extended periods:3. Intermittent (10% - 50% of the time)

F. Risk of back injury from moving, lifting or positioning patients, equipment, or materials:2. Occasional (< 10% of the time)

G. Repetitive motion:3. Intermittent (10% - 50% of the time)

H. Working at heights above 4 feet:1. Never

I. Working in confined spaces:1. Never

J. Risk of injuries from use of equipment on the job:2. Occasional (< 10% of the time)

K. Job-related travel:2. Occasional (< 10% of the time)

L. Loud noises:1. Never

M. Temperature extremes:1. Never

N. Hazardous chemicals and fumes including waste:2. Occasional (< 10% of the time)

O. Radiation:1. Never

P. Burns:1. Never

Q. Cuts/Punctures:2. Occasional (< 10% of the time)

R. Bloodborne/airborne pathogens:2. Occasional (< 10% of the time)

S. Recombinant DNA or viral vectors:1. Never

T. Combative/violent people:1. Never

U. Animal handling (including carcasses):1. Never

V. Please specify other(s) and amount of exposure (i.e. Occasional, Intermittent or Regular): N/A

Physical Demands

This position requires intermittent sitting at a computer workstation for extended periods of time; performing tasks with repetitive motions (such as typing); intermittent standing or walking with objects weighing up to 10 pounds; occasional standing or walking with objects weighing up to 25 pounds; and occasional lifting, pushing, or pulling objects weighing up to 50 pounds.

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