Authorization Coordinator WFH

About the role

The Authorization Coordinator is responsible for timely and accurate processes associated with some or all of the following job duties; pre-certification, obtaining and certifying authorizations, assisting with appeals of authorizations. Additionally, collaborates with the referral coordinator to ensure that all approvals are obtained.

Responsibilities

• Responsible for review and completion of prior authorizations to ensure timeliness of appointments, testing, procedures, and claims filing.
• Obtain clinical information (including but not limited to medical history, diagnosis, and any relevant lab reports) necessary to complete the Prior Authorization to include insurance requirements.
• Follow the criteria for all services requiring prior authorizations and submit requests in a timely manner.
• Ensure appropriate documentation is entered into the standard billing system.
• Ensures that this documentation entry is performed in all needed systems.
• Tracks status of prior authorizations via payor authorization portals.
• Reviews denied claims for clinical accuracy, corrects errors for claims resubmission.
• Clearly support patient experience through patient-centered communications demonstrating excellent customer service skills.
• Communicate with insurance companies to pre-certify/authorize/amend services.
• Recommend new approaches, policies, and procedures to influence continuous improvements in department's efficiency and services performed.
• Actively participate in problem identification and coordinates resolution between appropriate parties.
• Utilize appropriate communication system to facilitate communication with hospital partners.
• Ensure appropriate documentation is entered in standard format in billing system. This should be performed in the applicable Health Information System (i.e. Source systems) and if necessary, any other subsidiary systems if they are not automatically updated.
• Research Patient Visit History to ensure compliance with payor specific payment window rules; appropriately communicate patient payment responsibilities and guide them through needed steps.
• Performs Other Related Job Functions As Assigned.

Qualifications

• One year of related experience with medical insurance plans and/or Medicare benefits verification required.
• One-year medical clinic, urgent care, or hospital care setting experience preferred.
• Prior Authorization Experience Preferred.

Skills

Practice and adhere to the Code of Conduct and Mission, and Value Statements.

Benefits

Work from Home, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include: Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services; Wellbeing support, including free counseling and referral services; Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence; Savings and retirement resources, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling; Education support through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing.

Schedule

Full time (Monday - Friday, day shift), no nights, no on-call, no weekends, no holidays.

Pay

Details about pay are not specified in the job posting.

Supporting HCA Healthcare

HCA Healthcare has been recognized as one of the World’s Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in costs for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

Equal Opportunity Employer

We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.