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Authorization Coordinator – Licensed Practical Nurse, Imaging, Commercial
Sentara HealthAuthorization Coordinator/LPN reviewing clinical data, benefits, and insurance enrollment for Sentara Health Plans’ imaging services. Remote full-time role in Virginia.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in clinical review and authorization processes, ensuring compliance with regulatory standards and accuracy in claims processing. Proficient in utilizing clinical decision support tools and validating member benefits within managed care environments.
Highest-signal resume keywords
Licensed Practical Nurse (LPN) Nursing License3 Years Clinical Experience as an LPNKnowledge of Managed Care ContractingFamiliarity with NCQA StandardsExperience with MCG and InterQual Tools
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical ReviewAuthorization ProcessesClaims ProcessingRegulatory ComplianceBenefit Validation
Tools & Technologies
MCG ToolsInterQual Tools
Certifications & Qualifications
Licensed Practical Nurse (LPN) Nursing License
Industry Keywords
Managed CareClinical ProtocolsGovernment PayersSelf-Funded PayersCommercial Payers
About the role
Key responsibilities & impact- Review clinical information received from physicians and other clinical providers to ensure it is substantial enough to authorize services
- Analyze clinical information to ensure requested services are authorized according to clinical protocols
- Validate member benefits for requested services
- Validate the accuracy of insurance enrollment information before authorizing services
- Ensure appropriate and accurate information is entered into the claims system for payment processing
Requirements
What you’ll need- High School Grad or Equivalent REQUIRED
- Licensed Practical Nurse (LPN) Nursing License – Compact/Multi-State License REQUIRED
- 3 years of related clinical experience as an LPN REQUIRED
- Experience may include a physician office, acute care, managed care, or clinic setting
- Knowledge of managed care contracting, clinical protocols, and clinical review requirements
- Knowledge of regulatory and compliance requirements for government payers, self-funded, and commercial payers
- Familiarity with NCQA standards and turnaround times for prior authorizations
- Familiarity with MCG and InterQual clinical decision support tools for prior authorizations and utilization review
- LPN Diploma or Associate level degree preferred
- Imaging and Health Plan experience preferred
Benefits
Comp & perks- Medical, Dental, Vision plans
- Adoption, Fertility and Surrogacy Reimbursement up to $10,000
- Paid Time Off and Sick Leave
- Paid Parental & Family Caregiver Leave
- Emergency Backup Care
- Long-Term, Short-Term Disability, and Critical Illness plans
- Life Insurance
- 401k/403B with Employer Match
- Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education
- Student Debt Pay Down – $10,000
- Pet Insurance
- Legal Resources Plan
- Opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met
- Family-friendly culture
- Opportunities for development and growth
- Tobacco-free environment