Authorization Coordinator / Greater Manchester Region Admn

Hartford HealthCare•Manchester, CT

1d•Onsite

About The Position

Hartford HealthCare is seeking an Authorization Coordinator to join its team in the Greater Manchester Region, which includes Manchester Memorial Hospital (a 249-bed community hospital), Rockville General (a 102-bed facility), a large multispecialty provider group, and visiting nurse services, serving a region of 300,000 people across 19 towns. The Authorization Coordinator reports to the Manager, Central Authorization Center. This role involves working directly with FCC, ASC scheduling, and physician's offices to ensure all necessary approvals, precertification, and authorizations are in place for scheduled patient services in outpatient ancillary departments. Key responsibilities include verifying patient insurance information, obtaining managed care authorizations, following up on missing data, and resolving insurance and Medicare claim denials by initiating code and billing corrections to ensure payment. The position is also responsible for monitoring and obtaining authorizations for 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.
Excellent English written and verbal skills.
Basic computer and keyboard skills for use of the Meditech system.
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.
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.