Authorization and Reimbursement Coordinator

Trinity Health•Hartford, CT

About The Position

Saint Francis Hospital and Medical Center and member of Trinity Health of New England is looking for an Authorization and Reimbursement Coordinator to join our team in the Mandell Multiple Sclerosis Center. Our vision is to provide state-of-the-art healthcare to those within our local communities, creating a positive impact for each individual that walks through our doors. Position Purpose The Authorization and Reimbursement Coordinator is responsible for ensuring appropriate and accurate submission of insurance prior authorization requests for outpatient hospital infusion services. Attention to detail and excellent writing skills are required to follow-up and track prior authorization responses. Additional business responsibilities to include oversight of the denials and write offs related to infusion services to ensure timely follow up with pending claims. Serves as a resource to other Mandell MS Center team members concerning patient insurance plans or billing questions.

Requirements

High School diploma or equivalent
Five or more years of experience in a health care environment with exposure to the benefit verification process demonstrating progressive responsibilities
Attention to detail and excellent writing skills are required to follow-up and track prior authorization responses

Nice To Haves

Bachelors Degree in Business Administration or related field preferred
Experience with obtaining/authorizing services with various insurance companies preferred and experience with insurance benefits and pharmaceutical assistance programs for high dollar infusion services preferred

Responsibilities

Interpret insurance coverage, understand outpatient hospital insurance benefits and review clinical documentation for prior authorization submissions
Provide support to patients with questions regarding infusion costs, sponsored assistance programs and potential balances to be incurred with high-dollar infusions that are rendered
Provide support to patients related to step therapy criteria prior to initiating infusion therapy and educates patients on the process to initiate services
Communicate to registration, billing and case management concerning billing when necessary
Communicate with insurance carriers, as well as patients via phone or written correspondence
Prepare authorization requests for patients being infused at outside infusion Sites
Review medical records to submit appropriate medical information for review as part of the authorization process
Identify trends as it relates to authorization approvals, denials, and/or payment and assist with action planning with management team