Prior Authorization Coordinator RCM

Position located in Miramar, Florida.

Schedule

• Monday through Friday, 8:30am–5:00pm or 9:00am–5:30pm
• After 90 days, remote work on Fridays

Responsibilities

• Ensure quality and accuracy of patient insurance information, including certification periods, billing addresses, policy numbers, and authorization numbers
• Prioritize and process incoming Insurance Verifications and Prior Authorization requests
• Verify patient Medicaid, private insurance, and self-pay payor sources via telephone or online systems
• Obtain authorization from private insurance and other payor sources via telephone, facsimile, or online systems while maintaining compliance with medical record confidentiality regulations
• Maintain authorization extensions for all patients as appropriate
• Refer authorization requests requiring clinical judgment to Prior Authorization Supervisor and clinical support staff
• Obtain information from agencies to assist with receiving authorizations and re-authorizations from private insurance and other payor sources
• Assist other departments and Care Centers in the efficient collection of client and payor information to ensure accuracy
• Enter all hospice benefit information into Registration Tool and patient accounting system
• Respond to calls, emails, and other inquiries regarding the status of outstanding referrals and/or authorization information
• Provide administrative support to the department as needed
• Complete Payor Information Form (PIF) and Payor Change Request Forms (PCR) to meet payor and client needs for accurate reimbursement
• Update Contracting Coordinator of payor information changes
• Coordinate with members, providers, and key departments to promote understanding of Prior Authorization, Referral, and Insurance Verification requirements and processes
• Communicate efficiently, effectively, and timely to resolve issues pertaining to verification and authorization processes
• Access Medicare’s Common Working File (CWF) to verify eligibility if a patient has terminated coverage with a private insurance carrier

Requirements

• At least two years of related healthcare Revenue Cycle experience, preferably within registration and financial clearance
• Understanding of medical terminology and clinical documentation
• Clear understanding of the impact insurance verification and prior authorization has on Revenue Cycle operations and financial performance
• Demonstrated knowledge of commercial insurance carriers’ guidelines and criteria for verification, authorization, and reimbursement
• Strong customer service skills when responding to questions and inquiries from internal and external customers
• Ability to prioritize and manage multiple tasks simultaneously in a dynamic work environment
• Proficiency with PC-based office productivity tools (e.g., Microsoft Outlook, Microsoft Excel)
• High School diploma or GED required