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Prior Authorization Coordinator
IVX HealthPrior Authorization Coordinator at IVX Health reviewing and processing prior authorizations for specialty treatments. Role supports patient care and requires expertise in prior authorizations and payer guidelines.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in Prior Authorization processes, including submission and tracking, while ensuring compliance with payer guidelines. Strong communication skills facilitate effective interactions with patients, clinical staff, and insurance representatives.
Highest-signal resume keywords
Prior Authorization ExpertiseExceptional Communication SkillsElectronic Health Records (EHR) ProficiencyDetail-OrientedSelf-Motivated
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Prior Authorization ProcessingClinical Documentation ManagementMedication Approval CriteriaClaims ResolutionWorkflow Efficiency Improvement
Soft Skills
Effective CommunicationProblem-SolvingAccountability
Tools & Technologies
EHR SystemsPayer PortalsMicrosoft Office Suite
Certifications & Qualifications
Certified Medical Assistant (CMA)
Industry Keywords
BiologicsOncologySpecialty TherapiesPayer GuidelinesMedical Documentation
About the role
Key responsibilities & impact- Review and Process Prior Authorizations – Thoroughly review Prior Authorization orders and ensure timely and accurate completion.
- Manage Clinical Documentation – Obtain and assess necessary clinical information such as medical history, diagnosis, and lab reports to support Prior Authorization submissions.
- Submit and Track Prior Authorizations – Follow criteria for medication approvals and accurately submit requests to insurance providers.
- Resolve Authorization Issues – Investigate and resolve outstanding medical documentation concerns and assist in resolving denied claims.
- Support Patients and Providers – Communicate effectively with patients, clinical staff, and insurance representatives regarding the Prior Authorization process.
- Ensure Compliance and Process Improvement – Stay up to date with evolving payer policies and identify ways to enhance workflow efficiency.
- Perform Additional Duties – Take on other responsibilities as assigned to support patient care and operational objectives.
Requirements
What you’ll need- Prior Authorization Expertise is Essential – You must have hands-on experience with prior authorizations for biologics, oncology, or specialty therapies, along with a strong understanding of payer guidelines.
- Exceptional Communication Skills – This role involves frequent interaction with clinical teams, insurance companies, and patients. You must be able to communicate clearly, professionally, and persistently follow up when needed.
- Self-Motivated and Accountable – If you work remotely, you are expected to be present, engaged, and consistently perform at a high level without direct supervision.
- Tech-Savvy and Detail-Oriented – Proficiency in Electronic Health Records (EHR) systems, payer portals, and Microsoft Office Suite is required.
- High School Diploma or GED required.
- Associate’s degree in Medical Office Management, Medical Insurance, or Medical Coding is a plus.
- Minimum of three (3) years of experience in hospital or clinical service access, physician office scheduling, or a similar role.
- Certified Medical Assistant (CMA) is a plus.
- Experience with prior authorizations for biologics, oncology, or specialty therapies preferred.
Benefits
Comp & perks- Comprehensive Healthcare – Medical, dental, and vision coverage, including prescription drug plans and telemedicine services.
- Flexible Savings Options – Choose from Health Savings Accounts (HSA) and Health Reimbursement Arrangements (HRA) to manage healthcare costs.
- Supplemental Protection – Accident, critical illness, and hospital indemnity plans to provide additional financial security.
- Dependent Care FSA – Pre-tax savings for eligible childcare and dependent care expenses.
- 401(k) Retirement Plan – Secure your future with a competitive company match.
- Disability Coverage – Voluntary short-term and long-term disability plans to protect your income.
- Fertility and Family Support – Resources and benefits designed to support fertility care and family planning.
- Life and AD&D Insurance – Financial protection for you and your loved ones.
- Counseling and Wellness Support – Free resources to support emotional, physical, and financial well-being.
- Education Assistance – Tuition reimbursement and certification support to help you grow in your career.
- Continuing Education – Access to a CEU library for ongoing professional development.
- Charitable Giving and Volunteer Program – Matched donations and paid volunteer time off to support causes you care about.
- Employee Referral Bonus – Earn rewards for helping us find top talent.