Authorization Coordinator Edinburg ENT

Driscoll Children's Hospital•Edinburg, TX

About The Position

The Authorization Coordinator uses the EPIC electronic medical record system to coordinate surgical scheduling with surgical staff and patients’ families. The role verifies insurance coverage for hospital services, obtains authorizations for inpatient and outpatient surgeries, and ensures required surgical clearances are obtained before procedures. The coordinator serves as the primary liaison among the hospital operating room, physicians, and their designees regarding surgical scheduling, and applies elective-surgery scheduling rules fairly and consistently. The position also connects families of uninsured patients who urgently need surgery with the hospital financial coordinator. The coordinator maintains confidentiality and follows hospital policies and procedures. Duties include obtaining insurance pre-certifications and prior authorizations, coordinating surgical clearances, medications, durable medical equipment, home health, transplant-related labs and ancillary services, and services provided by outside vendors or collaborating surgeons. The role manages and updates the EPIC surgical scheduling system, enters accurate scheduling information, optimizes use of elective operating time and surgical equipment, troubleshoots scheduling-system issues, and obtains parent or guardian signatures on hospital surgical consents. Other related duties may be assigned by the immediate supervisor or hospital administration.

Requirements

High school diploma or GED, and 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.
Call insurance companies to determine pre-certification requirements.
Obtain prior authorizations for inpatient and outpatient services for patient cases.
Ensure required surgical clearances are obtained before scheduled surgeries.
Ensure medications requiring prior authorization are authorized and ready for surgery.
Coordinate with durable medical equipment companies on authorization for wound care vacuums.
Coordinate home health services before patient discharge.
For kidney transplant patients, coordinate required labs and ancillary services for surgery.
Coordinate with outside vendors supporting physicians, including ENT and Urology, for applicable surgeries.
Coordinate surgeries with other surgeons, including Plastic Surgery, Neurology, and Pulmonology, when patients require multiple services.
Act ethically and follow corporate compliance and integrity guidelines.
Enter appropriate data for accurate scheduling of elective surgical procedures.
Manage schedules to optimize use of elective surgical time and surgical equipment.
Maintain and update the EPIC surgical scheduling system.
Troubleshoot scheduling-system problems and identify and implement corrective actions.
Obtain parent or guardian signatures for hospital surgical consents.
Coordinate surgical scheduling with surgical staff and patients’ families.
Verify hospital insurance coverage and obtain authorizations for inpatient and outpatient surgical benefits.
Serve as the primary liaison between the hospital operating room, physicians, and their designees regarding surgical scheduling.
Apply elective surgical scheduling rules fairly and consistently.
Connect families of uninsured patients who urgently need surgery with the hospital financial coordinator.