Authorization Coordinator

Eastern Connecticut Health Network•Manchester, CT

57d

About The Position

This position reports to the Manager, Central Authorization Center and works directly with FCC, ASC scheduling and physician's offices to ensure all required approvals, precertification/ authorizations are in place to proceed with the scheduled patient services for outpatient ancillary departments. Verifies receipt of patient insurance information, including managed care authorizations; follows up to obtain missing patient and/or insurance pre-authorization data as required. Researches and resolves reasons for insurance and Medicare claim denials, initiates needed code and billing corrections when appropriate to ensure payment receipt for services provided. This position is responsible for monitoring and obtaining all inpatient and outpatient admissions and procedures.

Requirements

High School degree required.
2 years Hospital or medical office insurance/ authorization /precertification/referral work experience.
2 years customer service.
Knowledge of Medical Insurance and authorization process.
Current with CPT and ICD-10 Codes.
Medical Terminology knowledge.
Must have excellent English written and verbal skills, basic computer and keyboard skills for use of the Meditech system.
Customer service.
Experience in meeting deadlines in fast paced multitasking environment.

Nice To Haves

Associate's degree preferred.

Responsibilities

Obtains Insurance eligibility and benefits and documenting in ADT system. (prior to date of service and or upon admission).
Notification of admissions to insurance carriers by various methods: online, telephonically, by fax, as needed to ensure notification requirements are met in a timely manner preventing any denials and nonpayment of services.
Obtains authorizations prior to date of service. Working closely with physician offices to ensure authorizations are obtained by 2pm day before surgery /service. Notifies OR Director of any issues of accounts without authorizations and possible cancelations due to no auth obtained.
Documents clearly in ADT system authorizations, issues, etc.
Works closely with Case Management and Behavioral Health communicating necessary information to ensure authorizations for admissions obtained.
Monitors authorizations obtained and documented ensuring conditions of notification have been met and denials are prevented.
Verifies insurance policy benefit information and obtains Authorization/Precertification prior to the patient's visit, scheduled surgery, procedure or admission, and/or immediately following the admission.
Assists in identifying problems and ensures that the insurance is accurate on the patient's account.
Assures insurance information and appropriate referrals have been completely and accurately obtained.
Responsible for eligibility denial management ensuring accurate insurance information by making corrections on patient accounts received from claim rejections or eligibility failures.
Reviews patient documentation to assure that proper managed care pre-authorizations have been obtained where required. When necessary, follow up with personnel in the ordering Doctor's office to obtain missing authorization or insurance information. Relays important pre-authorized managed care coverage information to the Radiologists in order to avoid non-payment for services provided that were not pre-authorized.
The incumbent assigns proper procedural codes to reports and inputs Current Procedural Terminology (CPT) and diagnostic codes into the billing system for all related services provided. Assures documentation for Hospital and Clinic Radiology services is complete and accurate with appropriate (CPT) codes and diagnostic (ICD-9CM, and ICD-10) codes.

Benefits

Generous Vacation that is front-loaded based on budgeted hours. Ex. 40 hours/ week = 26 days a year!
Sick Time on an accrual basis
401(k)/Medical/Dental/Vision Insurance/Employee Assistance Program/Voluntary Benefit Options
Tuition Reimbursement- eligible after 3 months of employment!
Free Parking at all work sites
Perk Spots (Discounts at local retailers, restaurants, travel, and childcare centers)
Career Growth within the organization via career ladders, committee involvement, and more.

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