Authorization Coordinator

🔥 5 minutes ago

🏄 California – Remote

🏄 California – Remote

💵 $34 - $42 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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Stanford Medicine Children's Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

📚 Education

🔬 Science

💰 Grant on 2025-11

Healthcare • Education • Science

Stanford Medicine Children's Health is the pediatric arm of Stanford Medicine centered on Lucile Packard Children’s Hospital Stanford. It operates a network of care (about 65 Bay Area locations) delivering comprehensive pediatric, obstetric and newborn services and a broad range of pediatric specialties and surgical programs (including cancer, heart, transplant, orthopedics, pulmonary, brain & behavior). The organization offers in-person and virtual visits, online second opinions, family and financial support services, community classes and continuing medical education for health professionals, and engages in research and innovation (VR, robotic surgical assistance, 3D imaging, AI applications) to advance pediatric care.

📋 Description

• Provide day-to-day financial clearance of scheduled services assigned to the Authorization department work queues • Serve as a resource for departments on complex referral and authorization issues and provide problem resolution • Act as a patient and family advocate between obtaining necessary provider information and fulfilling payer referral/authorization requirements • Collaborate with providers and service-site staff to obtain referrals and authorizations • Track and document patient accounts, authorization status, follow-up activities, and payer issues • Prioritize clinically urgent cases and secure authorizations in advance to minimize financial risks • Process and follow up on denied authorizations, peer-to-peer requests, and medical-justification requirements • Research, review, correct, and resubmit authorizations as needed • Clear authorization claims edits holding claims according to department metrics and standards • Investigate, resolve, and document insurance issues and contact relevant stakeholders • Coordinate with contracting to obtain letters of agreement for patients with non-contracted coverage • Inform the Authorization Assistant Manager about potential deferrals or denials of elective/non-emergent services • Communicate with access nurses and clinicians for triage and insurance issue resolution • Perform other assigned duties and comply with hospital safety, quality, ethical treatment, and patient-care requirements

🎯 Requirements

• High school diploma or GED equivalent • Two years of directly-related experience • Ability to analyze operational and procedural problems and develop, recommend and evaluate proposed solutions • Ability to speak and write effectively at a level appropriate for the job • Ability to work well with individuals at all levels of the organization • Knowledge of computer systems and software used in the functional area • Knowledge of Medical Terminology • Knowledge of Medicare, Medi-Cal, Workers Comp, Managed Care (HMO, PPO, POS, etc.), and Children's Health Programs (CCS, GHPP, Healthy Families, etc.) • Must abide by Joint Commission requirements, hospital policies and procedures, Service Standards, and Code of Conduct • Must participate in ongoing education and training, and comply with safety, quality, and National Patient Safety Goals programs

🏖️ Benefits

• Benefits eligible • Full-time employee position • Continuing education • State-of-the-art facilities • Reasonable accommodations for individuals with disabilities • Equal opportunity and non-discrimination employment practices

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