Authorizations & Data Coordinator - Rehab - Full-Time - Days - Bayfront Hospital - St Petersburg

Position Summary

This position supports the admissions team by receiving and processing referrals, serves as an Insurance Authorization Specialist, and assists in patient admission.

About the Role

Orlando Health Bayfront Hospital is a comprehensive tertiary care facility with a long history of serving the St. Petersburg area. It is a 480-bed teaching medical center with nationally recognized care in various specialties. The hospital's Level II Trauma Center is the only adult trauma center in Pinellas County, and it partners with Johns Hopkins All Children's Hospital for Level III Regional Perinatal Intensive Care Centers.

Essential Functions

• Completes entry of referrals and/or authorizations into EHR.
• Verifies Insurance information through Availity, One Source, Passport, United online portal and VA.
• Communicates with physician advisors and coordinates peer-to-peer discussions for authorizations that have been denied.
• Transcribes faxed referral requests via On-Base fax system into EHR.
• Sets ICD-10 diagnosis code to authorization requests.
• Sends for insurance authorization, tracks authorization requests, and communicates effectively with internal and external customers (PCP, patient, clinical departments, etc.) to obtain the required authorization needed for hospitalization.
• Collaborates with Clinical Liaisons to ensure all necessary insurance information is collected prior to admission.
• Maintains current knowledge of referral and authorization requirements based on payer-specific guidelines.
• Maintains working knowledge of ICD-10 codes.
• Demonstrates a basic knowledge of third-party reimbursement requirements and regulations.
• Maintains ability to review medical records and identify information important to admission.
• Maintains positive relationships with Insurance point of contact.
• Exhibits competency in the use of registration systems, electronic verification tools, and Web-based resources.
• Understands the importance Orlando Health places on providing exemplary customer service.
• Performs job in a manner that helps meet customer service goals.
• Exhibits a positive and professional approach and always communicates effectively with customers and team members.
• Maintains flexibility in work schedule availability that allows department to change/modify work schedule to meet departmental needs.
• Investigates insurance denials, resubmits requests, and assists appeals when needed.
• Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA, and other federal, state, and local standards.
• Maintains compliance with all Orlando Health policies and procedures.

Other Related Functions

• Faxes/copy materials as requested.
• Adheres to corporate and departmental policies regarding confidentiality of patient records, physician information, system data, and other clinical data.
• Maintains records and documentation of work performed in a timely, organized, and easily retrievable fashion.
• Maintains confidentiality of data and information in compliance with HIPPA regulation and Orlando Health policies.

Qualifications

• High school graduate or equivalent.
• Medical terminology knowledge.
• Two (2) years’ experience in supporting nursing/clinical leadership.
• Working knowledge of word processing, spreadsheet, presentation, and database software management.
• Experience processing referrals and/or authorizations.

Benefits

Includes education & career growth assistance, comprehensive health & wellness coverage and resources, financial & retirement planning with company match, excellent company culture and work-life balance, family & pet support, and more!