Insurance Coordinator/Prior Authorization Specialist

Responsible for managing prior authorizations for musculoskeletal services. Works closely with other members of the billing team as liaison to communicate workflow. Review clinical documentation for medical necessity. Interpret payer guidelines. Track and follow up on pending authorizations. Manage denials and appeals. This role will also include responsibility for coordinating and processing patient referrals through the VA Community Care Network. This will include verifying eligibility and submitting and tracking authorization/referral requests through the VA portal (HSRM).