Authorization Coordinator Edinburg ENT

DRISCOLL HEALTH PLAN•Edinburg, TX

About The Position

The Authorization Coordinator uses the EPIC EMR system to coordinate and schedule surgeries with surgical staff and patients’ families. The role verifies hospital insurance coverage and obtains authorizations for inpatient and outpatient surgery. It also ensures that required surgical clearances, medications, and related services are arranged before surgery. The coordinator serves as a liaison among Driscoll Children’s Hospital’s operating room, physicians and their designees, patients’ families, and the hospital financial coordinator when an uninsured patient urgently needs surgery. The position supports fair and consistent scheduling of elective procedures and manages surgical scheduling data and resources.

Requirements

High school diploma or GED, plus two to three years of related medical-field experience and/or training, or an equivalent combination of education and experience.
Experience with ICD-10 and CPT coding.
Strong knowledge of clinical and medical practice operations, procedures, terminology, and administrative procedures.

Responsibilities

Maintain confidentiality and adhere to hospital policies and procedures.
Contact insurance companies regarding pre-certification requirements and obtain prior authorizations for inpatient and outpatient services.
Ensure required surgical clearances are obtained before scheduled procedures.
Obtain prior authorizations for medications needed for surgery.
Coordinate with durable medical equipment companies regarding authorized wound care vacuums.
Coordinate home health services before patient discharge.
For kidney transplant patients, coordinate required labs and ancillary services.
Coordinate with outside vendors supporting physicians, including ENT and Urology, for applicable surgeries.
Coordinate procedures with other surgeons, including Plastic Surgery, Neurology, and Pulmonology, when patients need multiple services.
Follow ethical business practices and corporate compliance and integrity guidelines.
Enter data needed for accurate scheduling of elective surgical procedures.
Manage schedules to optimize use of elective surgical time and equipment.
Maintain and update the EPIC surgical scheduling system, troubleshoot scheduling issues, and implement corrective actions.
Obtain parent or guardian signatures for hospital surgical consent forms.
Act as a liaison among the operating room, physicians and designees, patients’ families, and the hospital financial coordinator when needed.
Apply scheduling rules fairly and consistently.