Preauthorization Coordinator - 991735

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Nova Southeastern University (NSU) was founded in 1964, and is a not-for-profit, independent university with a reputation for academic excellence and innovation. Nova Southeastern University offers competitive salaries, a comprehensive benefits package including tuition waiver, retirement plan, excellent medical and dental plans and much more. NSU cares about the health and welfare of its students, faculty, staff, and campus visitors and is a tobacco-free university.

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Primary Purpose:

Secures insurance preauthorization for surgical and treatment cases across facilities, manages case-level insurance coordination, and ensures all required medical clearances are obtained and submitted before a patient’s scheduled OR appointment.

Job Category: Non-Exempt

Hiring Range: 

Pay Basis:  Hourly

Subject to Grant Funding? No  

Essential Job Functions: 

1. Obtains and manages insurance preauthorization for all treatments and cases.
2. Tracks authorization status from initiation through approval, following up proactively on pending or delayed requests.
3. Identifies and resolves authorization issues (denials, missing documentation, payer requirements) before they impact scheduled procedures.
4. Verifies patient insurance eligibility and benefits relevant to scheduled treatments.
5. Maintains accurate, up-to-date case tracking records (status of authorization, clearance, and any outstanding requirements) accessible to scheduling and clinical staff.
6. Serves as the primary point of contact for insurance-related questions on assigned cases.
7. Communicates with insurance carriers to resolve authorization or coverage discrepancies.
8. Confirms medical clearance requirements for each case based on procedure type and facility requirements.
9. Tracks clearance status and follow up with referring providers/patients to ensure clearance is obtained with adequate lead time before the OR date.
10. Submits required clearance documentation to the hospital ahead of the scheduled appointment to prevent day-of cancellations.
11. Escalates at-risk cases (missing or delayed clearance) to scheduling and clinical leadership.
12. Partners with the Surgical Scheduling Coordinator to ensure OR and clinic dates are not confirmed or held without authorization and clearance status accounted for.
13. Performs other duties as assigned.
14. Completes special projects as assigned.

Job Requirements: 

Required Knowledge, Skills, & Abilities: Knowledge:
1. Health insurance payer requirements, prior authorization processes, and medical necessity documentation standards.
2. Medical terminology and surgical/procedural terminology sufficient to interpret orders and clearance requirements.
3. HIPAA and patient privacy requirements as they relate to insurance and medical record handling.
4. English Language - General knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.
5. Customer and Personal Service - General knowledge of principles and processes for providing customer and personal services. This includes needs assessment, meeting quality standards for services, and evaluation of user satisfaction.
6. Proficient knowledge of payer policies and regulations, including Medicare, Medicaid, and private insurance guidelines.

Skills:
1. Active Listening - Proficient skills in giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.
2. Speaking - Advanced skills in talking to others to convey information effectively.
3. Critical Thinking - Proficient skills in using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions, or approaches to problems.
4. Reading Comprehension - Advanced understanding of written sentences and paragraphs in work-related documents.
5. Judgment and Decision Making - Proficient skills in considering the relative costs and benefits of potential actions to choose the appropriate one.
6. Writing - Advanced skills in communicating effectively in writing as appropriate for the needs of the audience.
7. Complex Problem Solving - Proficient skills in identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.
8. Service Orientation - Proficient skills in actively looking for ways to help people.
9. Communication - Excellent verbal and written communication skills, with the ability to create engaging content.

Abilities:
1. Problem Sensitivity - The ability to tell when something is wrong or is likely to go wrong. It does not involve solving the problem, only recognizing there is a problem.
2. Ability to prioritize and manage competing deadlines across two facilities without missing authorization or clearance windows.
3. Ability to communicate clearly and professionally with insurance representatives, physicians’ offices, and patients under time pressure.
4. Deductive Reasoning - The ability to apply general rules to specific problems to produce answers that make sense.
5. Inductive Reasoning - The ability to combine pieces of information to form general rules or conclusions (including finding a relationship among seemingly unrelated events).
6. Collaboration - Ability to work effectively with colleagues and supervisors.
7. Ability to enter and verify information with accuracy.
8. Ability to maintain confidential information.
9. Ability to accurately handle financial transactions and reconciling accounts.

Physical Requirements and Working Environment:
1. Speech Recognition - Must be able to identify and understand the speech of another person.
2. Speech Clarity - Must be able to speak clearly so others can understand you.
3. Near Vision - Must be able to see details at close range (within a few feet of the observer).
4. Travel - Must be able to travel on a daily and/or overnight basis.
5. May be required to work nights or weekends.
6. May be exposed to short, intermittent, and/or prolonged periods of sitting and/or standing in performance of job duties.
7. May be required to accomplish job duties using various types of equipment/supplies, to include but not limited to pens, pencils, and computer keyboards.

Required Certifications/Licensures: 

Required Education: High school diploma or equivalent

Major (if required: 

Required Experience: Four (4) years of experience in insurance preauthorization, medical billing/insurance verification, or healthcare case coordination.

Preferred Qualifications: 

1. Experience working across multiple facilities or hospital systems.
2. Familiarity with surgical/OR scheduling workflows and medical clearance requirements.
3. Experience in a surgical specialty, orthopedic, or similarly high-acuity practice setting.
4. Certification in medical billing/coding or insurance authorization (e.g., CPC, CMAA).
5. Associate’s degree.

Is this a safety sensitive position? No  

Background Screening Required?  Yes  

Pre-Employment Conditions: 

Sensitivity Disclaimer: Nova Southeastern University is in full compliance with the Americans with Disabilities Act (ADA) and does not discriminate with regard to applicants or employees with disabilities and will make reasonable accommodation when necessary.

NSU is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status or any other legally protected status.