Job description
Overview:
All Copley Hospital employees must show proof of Covid-19 vaccination upon hire. Responsibilities:
Experience Requirements:
Experience Desired:
Three years prior-authorization experience in physician practice or hospital setting.
Skill Requirements:
The Authorization Coordinator plays a key role in the patient experience and Revenue Cycle of the organization. This position will work with service providers and insurance companies to obtain all necessary prior authorizations. To be successful in this position you will need to thrive in a fast pace environment, be detail oriented, flexible, highly organized, self-motivated and muse provide outstanding service to both internal and external customers. Being a positive team player is a must.
All Copley Hospital employees must show proof of Covid-19 vaccination upon hire.
- Review structured clinical data, matching it against specific medical terms and diagnoses or procedure codes and follow established procedures for authorizing request. Refer request for further review and follow-up on pending authorizations and appeals of rejected authorizations in a timely manner.
- Review and evaluate inpatient and outpatient admissions and procedures to ensure that appropriate and necessary authorization is obtained.
- Obtain and verify insurance benefits and other sources of account payment, making corrections when needed and document in appropriate EMR.
- Document in the appropriate EMR details of the authorization and insurance benefits information. Ensure that the service area or practice is aware that an authorization has been obtained or denied.
- Collaborate with patients, service providers, and insurance carriers to resolve questions that may delay or prevent authorization.
- Assist in the development and maintenance of prior authorization procedure manual.
- Assist in the collection and maintenance of prior authorization statistics; i.e. authorization request, authorizations obtained and denial information.
- Other assignments or projects as needed.
Education Required:
High School Diploma or Equivalent
Experience Requirements:
Three years' working in a physician or hospital administrative support setting.
Experience Desired:
Three years prior-authorization experience in physician practice or hospital setting.
Skill Requirements:
Excellent verbal, interpersonal, and organizational skills. Ability to work independently and with all levels or staff in a manner that values collaboration and compromise. Must be able to work in a rapidly changing health care environment. Demonstrate ability to exercise independent judgment and follow through.
Advanced knowledge of medical terminology, procedure and diagnosis codes, and health insurance benefits. Must be able to extrapolate and analyze data included in the medical record in order to obtain authorization for services. Word Processing and Spreadsheet knowledge.
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