Insurance Authorization Coordinator

Overview

Baptist Health System Hospital is committed to providing exceptional patient care in a supportive and collaborative environment. As a member of our team, you will work with advanced technology and be part of a healthcare community dedicated to making a positive impact on the lives of our patients.

Benefits

• Medical, dental, vision, and life insurance
• 401(k) retirement savings plan with employer match
• Generous paid time off
• Career development and continuing education opportunities
• Health savings accounts, healthcare & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits including pet insurance, legal insurance, accident and critical illness insurance, long‑term care, elder & childcare, auto & home insurance

Eligibility for benefits may vary by location and is determined by employment status.

Job Summary

The individual works under the direction of the RN Case Manager and/or Social Worker. Responsibilities include following up on patient accounts for authorization, documenting in the electronic system, escalating disputes, trending denied claims, assisting with authorizations for post‑acute care, and other duties as assigned.

Responsibilities

Utilization Management

• Validate patient demographic and payer information with patient/family and notify Patient Access of any corrections.
• Validate that all commercial/managed‑care discharges have appropriate authorization and notify the Director of Case Management of variances.
• Obtain daily authorizations by fax or phone and complete documentation.
• Escalate discharged cases lacking authorization or dispute notification.
• Ensure all clinical information required by payors is provided; alert assigned Case Manager and escalate to DCM if not completed timely.
• Trend dispute/denial patterns by payor and physician and report to DCM.
• Prepare denial information for Utilization Review Committee and revenue‑cycle meetings.
• Collaborate with Patient Access, Case Management, Managed Care, and Business Office to improve concurrent review process and avoid billing delays.

Transition Management

• Follow up on authorizations for post‑acute services.
• Make referrals for post‑acute services under direction of RN Case Manager or Social Worker using the Tenet Case Management documentation system.
• Follow up if referral requires payor authorization to discharge the patient.
• Complete tasks assigned by RN or LVN Case Manager and/or Social Worker.
• Prepare copies, send faxes, and make phone calls to arrange post‑acute services and ensure hospital information is communicated.
• Document all referrals and tasks in the Tenet Case Management system per policy.
• Provide Important Message follow‑up letters to Medicare beneficiaries as directed (10% daily, essential).

Compliance

• Adhere to federal, state, and local regulations and accreditation requirements affecting case management.
• Follow department structure, policies, and procedures to comply with CMS Conditions of Participation and Tenet policies (5% daily, essential).

Qualifications

• Minimum education: High School diploma or equivalent (required).
• Preferred education: Associate’s or Bachelor’s degree.
• Minimum experience: Excellent organizational, verbal, and written communication skills; demonstrated problem‑solving skills; computer literacy.
• Preferred experience: Acute hospital experience; data analytic skills.
• Preferred certifications/licensure: Paramedic, EMT, or Nursing Assistant.
• Required certifications/licensure: None.

Organization Description

Baptist Health System has more than 120 years of history caring for the community. The system includes six full‑service hospitals, a specialized children’s hospital with a dedicated pediatric emergency unit, a comprehensive cancer care network, fitness and rehabilitation centers, a physician network, imaging centers, ambulatory services, and the Baptist School of Health Professions. The mission is to help people achieve health for life through compassionate service inspired by faith.