Pre-Auth Coordinator

Client: Luminis Health / Anne Arundel Medical Center
Position: Pre‑Authorization Coordinator
Location: Remote
MUST sit in one of the following states: Maryland, Pennsylvania, Washington DC, West Virginia, Virginia, Texas, North Carolina, South Carolina, Tennessee, Georgia, Florida
Schedule: 9:00am-5:00pm EST

Day‑to‑Day Responsibilities
Initiate pre‑authorization requests to payers for inpatient, outpatient, elective, surgical, urgent, and emergent services
Communicate daily with insurance payers, patients, physician offices, and hospital clinical staff
Determine when prior authorization is required by reviewing diagnosis codes and CPT codes and confirming directly with payers
Use payer portals (e.g., Availity, BCBS) and phone outreach to obtain eligibility, benefits, and authorization details
Alert payers within required timeframes for emergency admissions (within 24 hours)
Proactively contact patients regarding deductibles and financial responsibility
Document copays, deductibles, coinsurance, OOP maximums, authorizations, and pre‑certifications accurately in the system
Coordinate with clinical teams when services must be rescheduled due to authorization or benefit limitations
Escalate non‑authorized accounts to leadership to protect hospital reimbursement
Monitor shared mailboxes, faxes, and phone lines and respond to PAVE account issues within defined SLAs

Responsibilities include, but are not limited to:
Verifying insurance eligibility and benefits
Obtaining and documenting prior authorizations
Communicating authorization issues to providers and clinical staff
Educating provider offices on authorization requirements
Performing quality assurance and accuracy checks
Supporting denial prevention through complete and timely documentation

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.

Must Haves
2+ years of hospital patient access, medical billing, or hospital business office experience
Hospital billing or facility experience mix with strong understanding of CPT codes
Knowledge of insurance terminology and authorization processes
ICD‑10 coding knowledge
Experience determining authorization requirements through payer communication
Comfortable picking up the phone and speaking directly with patients and payers
Understanding of coordination of benefits (primary vs secondary payer)
Independent worker who shows initiative
Experience working with ~45-50 accounts per day
Non‑smoker required
Flu shot required

Nice to Have
Epic Hospital Billing experience
Prior access to and navigation of payer portals
Revenue Cycle certifications:
1 or more Certifications preferred:
CRCE - Certified Revenue Cycle Executive
CRCP- Certified Revenue Cycle Professional
CRCS- Certified Revenue Cycle Specialist
CHAM – Certified Healthcare Access Manager
CHAA- Certified Healthcare Access Associate
CHFP- Certified Healthcare Financial Professional
CRCR- Certified Revenue Cycle Representative
Experience working both professional and facility billing

Benefit packages for this role will start on the 1st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.