Prior Authorization Coordinator
- Ensures quality and accuracy of the patient insurance information and that listed certification periods, billing addresses, policy numbers, authorization numbers, etc. are all entered correctly.
- Prioritizes and processes incoming Insurance Verifications and Prior Authorization requests.
- Verify the patient’s Medicaid, private insurance, and self-pay payor sources via telephone, or online systems.
- Obtain authorization from private insurance and all other payor sources requiring authorization via telephone, facsimile, or online systems while maintaining compliance to medical record confidentiality regulations.
- Maintains authorizations extension for all patients as appropriate.
- Refers authorization requests that require clinical judgment to Prior Authorization Supervisor and clinical support staff.
- Obtain information from agencies when necessary to assist with receiving authorizations and re-authorizations from private insurance and all other payor sources.
- Assist other departments and Care Centers in the efficient collection of client and payor information to ensure accuracy.
- Enter all hospice benefit information into Registration Tool and patient accounting system.
- Respond to calls, emails and other inquiries regarding the status of outstanding referrals and/or authorization information.
- Provides other administrative support to the department as needed.
- Complete Payor Information Form (PIF) and Payor Change Request Forms (PCR) when needed for the purpose of meeting payor and client's needs to ensure accurate reimbursement.
- Update Contracting Coordinator of payor information changes.
- Coordinates with members, providers and key departments to promote an understanding of Prior Authorization, Referral, and Insurance Verification requirements and processes.
- Communicate efficiently, effectively, and timely to resolve issues pertaining to the verification and authorization processes.
- Access Medicare's Common Working File (CWF) to verify eligibility in the event a patient has termed coverage with private insurance carrier if applicable.
- At least two years of related healthcare Revenue Cycle experience, preferably within registration and financial clearance.
- Understanding of medical terminology and clinical documentation.
- Clear understanding of the impact insurance verification and prior authorization has on Revenue Cycle operations and financial performance.
- Demonstrated knowledge of commercial insurance carriers' guidelines and criteria of verification, authorization and reimbursement.
- Demonstrated knowledge of customer service skills when responding to questions and other inquiries from internal and external customers.
- Ability to prioritize and manage multiple tasks simultaneously, and to effectively anticipate and respond to issues as needed in a dynamic work environment.
- A demonstrated ability to use PC based office productivity tools (e.g. Microsoft Outlook, Microsoft Excel) as necessary; general computer skills necessary to work effectively in an office environment.
- Ability to prioritize and effectively anticipate and respond to issues as they arise.
- High School diploma or GED required
- EOE/AA M/F/D/V
Qualifications
EDUCATION
SPECIAL INSTRUCTIONS TO CANDIDATES
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