Authorization Coordinator, RN

Baylor Scott & White Health • Sunnyvale, TX

111d

About The Position

Baylor Scott & White Medical Center - Sunnyvale is seeking an Authorization Coordinator that collaborates with Insurance verification, insurance CM, Hospital Case Manager UR/transition Planner and physicians to facilitate obtaining authorizations. The individual's responsibilities include but are not limited to the following actions: Follow up on patient accounts when authorization for stay is required, Fax numbers to Send clinical reviews, Follow up on each account during the stay and on discharge for authorization - document in the electronic system, Escalate any potential disputes or denial of accounts to Director of Case Management or designee, Trends disputed, Coordination of concurrent denials/preparation for appeal for retrospective denials, and other duties as assigned.

Requirements

• RN with current Texas Nursing license.
• 2 or more years with Medical Surgical Nursing experience - preferably Case Management experience.
• Able to communicate effectively in English, both verbally and in writing.
• Basic computer knowledge.

Nice To Haves

• Additional languages preferred.

Responsibilities

• Validates patient's demographic and payer information with patient/family and notifies Patient Access immediately if any corrections are needed.
• Validates that all commercial/managed care discharges have an authorization for status and level of care provided and notifies Director of Case Management (DCM) or designee of variances.
• Obtains authorizations daily by fax or phone and completes documentation daily.
• Escalates discharged cases at end of day that have no authorization or notification of dispute is provided by payor.
• Ensures all clinical needed by payors and updates are provided by alerting Case Manager assigned to case and escalating to DCM if not completed timely.
• Trends dispute/denial potential to DCM or designee by failure points in revenue cycle.
• Prepares denial information for UR Committee, Denial and Revenue Cycle Meetings.
• Collaborates with Patient Access, Case Management, Managed Care and Business office to improve concurrent review process to avoid denial or process delays in billing accounts.
• Adheres to federal, state, and local regulations and accreditation requirements impacting case management scope of services.
• Adheres to department structure and staffing, policies and procedures to comply with the CMS Conditions of Participation.
• Manages and operates equipment safely and correctly.
• Interacts professionally with patient/family and involves patient/family in the formation of the plan of care.
• Acts on performance improvement issues identified during CQI meetings.
• Actively participates in Case Management Committee, CQI, varying team meetings and other meetings, as appropriate.
• Maintains and respects confidentiality of patient/physician/personnel information.
• Demonstrates an ability to be flexible, organized and function under stressful situations.
• Maintains a good working relationship both within the department and with other departments.
• Consults other departments as appropriate to collaborate on patient care and performance improvement activities.
• Accurately determines type of assistance/setting/resources necessary for the patient/family and provides appropriate resources/assistance/list of facilities.
• Ensures documentation meets current standards and policies.

Benefits

• Competitive pay.
• Benefits provided based on your work assignment (Full-time, Part-time, or PRN).
• Modern Office Setting.
• On-Site Cafe' and Coffee Bar (Payroll Deduction available).
• Collaborative Teams.
• Team Member engagement opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Hospitals
• Education Level: Bachelor's degree