Prior Authorization Coordinator – 11:30am-8pm Full Time

• 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.

Qualifications

• 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.

EDUCATION

• High School diploma or GED required

SPECIAL INSTRUCTIONS TO CANDIDATES

• EOE/AA M/F/D/V