Insurance Coordinator - OP Approvals

Role OverviewThe Insurance Coordinator, OP Approvals manages outpatient insurance approvals and authorization workflows. You ensure timely approvals, accurate documentation, and compliance with payer rules. You protect revenue by preventing authorization denials and treatment delays.Key ObjectivesOperational ControlEnsure all outpatient services receive approvals before treatment.Maintain zero tolerance for unauthorized services.Performance MetricsAchieve approval turnaround within payer SLA timelines.Maintain less than 3 percent denial rate due to authorization errors.ComplianceEnsure adherence to DHA regulations and payer policies.Maintain complete audit ready authorization records.Core ResponsibilitiesAuthorization ManagementVerify insurance eligibility and benefits before initiating approval requests.Submit pre authorization requests with complete clinical documentation.Track approvals, extensions, and validity periods to prevent service disruptions.Escalate urgent or delayed approvals to payers and internal leadership.Documentation IntegrityEnsure physician orders, clinical notes, and diagnostic reports support medical necessity.Validate CPT and ICD coding alignment with requested services.Maintain organized digital records of approvals, correspondence, and payer responses.Payer CoordinationLiaise with insurance companies and TPAs to expedite approvals.Communicate approval status to front office, clinical teams, and patients.Clarify payer requirements and disseminate updates to relevant teams.Denial Prevention and ResolutionInvestigate approval denials and implement corrective actions.Identify trends in authorization rejections and recommend process improvements.Support resubmissions and appeals with enhanced documentation.Systems and ReportingManage authorization workflows within HIS and payer portals such as EclaimLink.Generate daily and monthly reports on approval volumes, turnaround times, and denial trends.Recommend automation opportunities to improve efficiency and tracking.Understand, follow and support all hospital infection control programs#J-18808-Ljbffr