Referral/Authorization Coordinator in Santa Monica, California at Balance Health

The Referral/Authorization Coordinator's main function is to secure funding approvals for our customers whether it be from private insurances, State funding, or any other type of funding source. This position serves as the liaison between many other teams and provides excellent customer service to employees as well as customers using their knowledge of how insurance verifications, medical policies, and insurance requirements/guidelines work. The Authorization Specialist is also responsible for maintaining accurate records of policies and insurances for employees to view and reference as needed.

Duties and Responsibilities

• Initiates prior authorizations, pre-determinations, and out-of-network gap exceptions.
• Initiates and follows through with authorization appeals.
• Follows up on all authorization requests in a timely manner and reports on progress to internal teams.
• Applies to and follows up on applications for funding through Government programs.
• Negotiates and obtains agreements with insurance companies for individual cases when necessary.
• Communicates internally and externally regarding authorizations, appeals, and exceptions.
• Assists in eligibility and benefits inquiries when necessary.
• Determines the authorization requirements of each health plan and keeps detailed records of the medical policies and requirements.
• Maintains accurate and complete documentation of all inquiries.
• Proactively communicates with team members regarding identified potential issues and concerns.
• Tracks patterns and trends of authorization issues from payers to eliminate future delays in authorization processing.
• Exhibits strong problem-solving skills through both verbal and written communications.
• Assists reimbursement team in authorization related corrections on rejected or denied claims.
• Answers in-bound calls and assists customers.
• Exercises the above with discretion and independent judgement.
• Performs other duties and works on special projects related to authorization.

• Proficient understanding of healthcare provider environment.
• Excellent problem-solving skills and attention to detail.
• Excellent customer service skills and professionalism.
• Ability to comfortably interface with various users across the organization.
• Proficiency with MS Outlook, Word, Excel, Adobe.
• Knowledge of insurance requirements regarding face-to-face documentation.

Education and Experience

• High school diploma or equivalent
• 1+ years of prior authorizations, pre-determinations, and out-of-network gap exceptions experience
• 1+ years of experience in a healthcare provider environment, podiatry is a plus

About Balance Health

Balance Health empowers people to live full lives by helping them improve and maintain mobility. We do this by bringing together leading podiatrists, orthopedic surgeons, vascular surgeons, and physical therapists and providing them the tools and resources necessary to deliver exceptional patient care. This mission has made us the fastest growing lower-extremity focused Physician Practice.