Insurance Authorization Coordinator

Whatever the role, everyone at Grady is part of something bigger. Choosing a career at Grady is choosing to be part of a legacy of service and commitment to our communities. If you want to make a difference, we want to hear from you.

Job Summary

The Insurance Authorization Coordinator is responsible for verifying third party coverage, ensuring correct coordination of benefits, obtaining and validating precertification/authorization for specified scheduled, urgent, emergent, outpatient or inpatient services in accordance with payer guidelines accurately and timely. This position communicates with patients, clinicians and other healthcare professionals to obtain appropriate clinical information required to secure precertification/authorization and ensure reimbursement optimization.

Responsibilities:

Verifies third party coverage or the possibility of third party coverage. Coordinate benefits for multiple coverages.

Opens Epic chart to review orders and assemble clinical information for obtaining precertification/authorization. This may include, but is not limited to, lab results, treatment plans, imaging results, CPT and ICD-10 Codes, etc.

Serves as a resource to clinicians as well as other hospital personnel as it relates to Medicaid and third-party payer requirements

Submits accurate patient/clinical information, date of service, diagnosis, plan of treatment, etc., via Medicaid Web Portal, Insurance Web Portal or by contacting the appropriate Utilization Management Review panel/group in accordance with the payer's guidelines.

Updates Epic to populate fields regarding the status of the precertification/authorization, such as, clinicals requested, clinicals sent, notes, approved, denied, etc.

Initiates appeal for precertification/authorization denials in accordance with the guiding principles for Medicaid and/or the third-party payer. Completes follow-up activity on denials to final resolution. Escalates final denials to supervisors and managers.

Reviews Epic Daily In-house Census, Work queues (WQ) and Department Appointment Report (DAR) to determine cases with third party coverage requiring precertification/authorization.

Works independently under general supervision and direction.

Updates the appropriate Hospital Account Record (HAR) immediately to ensure timely reimbursement once the precertification/authorization number is obtained.

Communicates effectively with patients, clinicians and other hospital personnel in a timely manner regarding additional clinicals required and delays in obtaining precertification/authorization as appropriate.

Maintains flexibility with job roles to adjust with the demands of the department's vision and scope of work.

QUALIFICATIONS:

3+ years of recent insurance and precertification/authorization experience in a healthcare environment.

10 years of Insurance and pre-certification/authorization experience

EDUCATION:

High school or GED

Core Competencies
These competencies reflect the values and behaviors expected of all Grady team members, regardless of role. They ensure that every employee contributes to safe, high-quality care, positive patient experience, and a collaborative work environment.

1. Patient-Centered Care - Demonstrates a commitment to delivering safe, compassionate, and high-quality care that prioritizes the well-being and satisfaction of patients and their families.
2.Integrity & Accountability - Acts ethically, maintains confidentiality, and accepts responsibility for actions, decisions, and outcomes.
3.Collaboration & Teamwork - Builds positive relationships, works effectively across departments, and supports colleagues to achieve shared goals.
4. Communication - Communicates clearly, respectfully, and effectively with patients, families, colleagues, and leadership.
5.Respect & Inclusion - Creates an inclusive environment by valuing diversity, treating others with dignity, and ensuring equitable care and opportunities for all.
6. Quality & Safety - Adheres to best practices, regulatory standards, and policies to ensure safe, reliable, and high-quality outcomes.
7. Adaptability & Resilience - Responds effectively to change, remains flexible in dynamic situations, and demonstrates resilience under pressure.
8. Continuous Improvement - Seeks opportunities to improve processes, skills, and outcomes through innovation, learning, and feedback.
9. Leadership & Professionalism - Inspires, guides, and develops individuals and teams while modeling professionalism, fairness, and transparency.
10. Employee Experience Focus - Champions a supportive and engaging employee journey that enables staff to thrive and, in turn, deliver exceptional patient care.

Grady Total Rewards
At Grady, we believe in supporting the health, well-being, and growth of every team member. Our Total Rewards package is designed to provide competitive pay and comprehensive benefits that make a difference in your life and career, including:

• Health & Wellness: Medical, dental, vision, and prescription drug coverage.

• Financial Security: Retirement savings plans with employer contributions, life insurance, and disability coverage.

• Work-Life Balance: Paid time off, holidays, and family leave benefits.

• Career Growth: Tuition reimbursement, professional development programs, and opportunities for advancement.

• Employee Support: Employee Assistance Program (EAP), wellness initiatives, and discounts on services.

Grady's Total Rewards are designed to ensure our employees feel valued, supported, and empowered, both at work and beyond.

Why Join Grady?
Grady Health System is more than a hospital - we are a vital part of Atlanta and the surrounding communities. For over 125 years, Grady has been committed to providing exceptional care, advancing health equity, and making a difference in the lives of those we serve. When you join Grady, you become part of a team that values excellence, compassion, innovation, and collaboration.

Here, every role matters. Whether you provide direct patient care, support our operations, or lead teams, you play an important part in fulfilling our mission. We offer opportunities to learn, grow, and build a meaningful career in an environment where your contributions are recognized and valued.

At Grady, we don't just work, we make an impact.

Equal Opportunity Employer Statement:
Grady Health System is proud to be an equal opportunity employer. We are committed to fostering a workforce where all employees feel valued, respected, and empowered to succeed. We prohibit discrimination and harassment of any kind based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other legally protected characteristic.

Grady is dedicated to creating an accessible work environment and provides reasonable accommodations to qualified individuals with disabilities to ensure equitable opportunities for success.