Authorization Coordinator

About the role

The Authorization/Benefits Coordinator at OCR is responsible for managing the surgical benefits process, ensuring accurate patient communication, and maintaining up-to-date records. This role requires strong communication skills and attention to detail.

Responsibilities

• Determines patient out-of-pocket expenses using estimates provided by surgery authorization personnel and patient insurance plans.
• Notifies patients of determined expenses and establishes payment arrangements according to guidelines and department protocols.
• Supports check-in personnel by providing answers to insurance eligibility questions, either over the phone, in person, or by follow-up with insurance carriers.
• Maintains accurate and updated notes in patient accounts regarding surgical benefits and pre-authorizations, and disseminates surgery authorization logs appropriately.
• Responds to insurance companies' requests for information in a prompt and professional manner, correcting errors and communicating account errors to the appropriate coordinator.
• Identifies problem accounts and communicates them to the supervisor for further action, following up on denials, claim suspensions, and severe reductions in reimbursement.
• Ensures consistent collection work by monitoring patient accounts for payment of surgical agreements, following up with patients and/or insurance coordinators regarding outstanding balances, and auditing coding and demographic data on visit tickets.
• Acts as a backup for surgery authorization personnel as needed, communicating concerns and risk management issues to the supervisor.
• Communicates all concerns, risk management issues, breakdowns in protocol, and constructive criticisms to the supervisor.

Requirements

• A high school diploma or equivalent is required.
• Minimum 1 year of experience in the insurance or medical industry, or equivalent experience with collections in a business/accounting department.
• Knowledge of medical terminology is preferred.

Physical Requirements

• The work environment is typically an office setting.
• The employee must be able to sit for extended periods and use hands and arms frequently.
• The employee may occasionally lift up to 25 pounds.

Benefits

• Medical, Dental, and Vision coverage
• Life and AD&D Insurance
• Short- and Long-term disability coverage
• Retail savings and profit-sharing plan participation
• Employee Assistance Program
• Paid holidays and paid time off
• Annual merit increases

Benefits Eligibility

Benefit eligibility is dependent on employment status and may require a waiting period. OCR is committed to equal employment opportunity and prohibits discrimination or harassment of any kind.