Prior Authorizations
Coordinator
Basic Objectives:
To manage and track prior authorization (PA) requests required for medical procedures, services, or medications. The coordinator ensures timely and accurate submission of authorizations to insurance providers and follows through to secure approvals, avoiding care delays.
Duties & Responsibilities:
- Submit prior authorization requests within 24 hours of receipt
- Use insurance portals or direct contact to ensure timely processing
- Track and follow up on pending PAs until resolution
- Document all communication and updates within the EMR/CRM
- Coordinate with clinical and billing teams for information accuracy
- Resolve delays by proactively communicating with payers
- Handle 20–25 authorization cases daily
Desired Outcomes:
- » 100% of PA requests submitted within 24 hours
- » Timely approvals leading to uninterrupted patient care
- » Accurate documentation in systems
- » Reduction in denied services due to authorization lapses
KPIS:
| KPI | What Does This Measure? |
|---|---|
| Submission Timeliness | Responsiveness |
| Authorization Approval Rate | Accuracy & quality |
| Pending Cases Tracked | Follow-through |
| Cases Completed Daily | Productivity |
| Submission Timeliness | Responsiveness |
