Authorization Coordinator

Stanford Medicine Children's Health•Palo Alto, CA

3h•$34 - $43•Remote

About The Position

The Authorization Coordinator provides day-to-day financial clearance for scheduled services assigned to the Authorization department and serves as a resource to other departments on complex referral and authorization issues. Reporting to the Authorization Assistant Manager and/or Supervisor, the coordinator advises on authorization-related questions and provides high-quality customer service in accordance with hospital practices, regulations, policies, and procedures. The position advocates for patients and families, coordinates with providers, clinical staff, payers, and other stakeholders, and helps resolve authorization and insurance issues.

Requirements

High school diploma or GED equivalent.
Two years of directly related experience.
Ability to analyze operational and procedural problems and develop, recommend, and evaluate proposed solutions.
Ability to speak and write effectively at a level appropriate for the job.
Ability to work well with individuals at all levels of the organization.
Knowledge of computer systems and software used in the functional area.
Knowledge of medical terminology.
Knowledge of Medicare, Medi-Cal, Workers’ Compensation, managed care plans (HMO, PPO, POS, etc.), and children’s health programs (CCS, GHPP, Healthy Families, etc.).

Responsibilities

Act as a patient and family advocate by obtaining necessary information from providers and meeting payers’ referral and authorization requirements.
Collaborate with providers and service-site staff to support successful referral and authorization processing.
Track and document authorization status, follow-up, and payer issues on patient accounts; help prioritize clinically urgent cases and obtain authorizations in advance to minimize financial risk.
Process and follow up on authorizations involving denials, peer-to-peer review, or additional medical justification requirements.
Research, review, correct, and resubmit authorizations as needed.
Clear authorization-related claim edits in a timely and effective manner, consistent with department and organizational metrics and standards.
Investigate, resolve, and document insurance issues promptly, contacting management, medical and clinical staff, ancillary departments, and administration as needed.
Coordinate with contracting to obtain letters of agreement for patients and families with non-LPCH-contracted coverage.
Inform the Authorization Assistant Manager of potential deferrals or denials of elective or non-emergent services that have not been approved before the service date.
Communicate with the access nurse or appropriate clinician for triage or help resolving insurance issues.
Perform duties in accordance with hospital policies and procedures, Service Standards, Code of Conduct, and applicable Joint Commission requirements; participate in ongoing education and training and support safety and quality programs.