Authorization Coordinator

Stanford Medicine Children's Health•Menlo Park, CA

2d•$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 questions and models high-quality customer service in accordance with hospital practices, regulations, policies, and procedures. The position advocates for patients and families, coordinates with providers and staff, and helps resolve authorization and insurance issues to support timely service and reduce financial risk.

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.
Effective speaking and writing skills appropriate to the role.
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 referrals and authorizations.
Track patient accounts and document authorization status, follow-up, and payer issues; help prioritize clinically urgent cases and obtain authorizations in advance.
Process and follow up on authorizations involving denials, peer-to-peer review, or additional medical justification.
Research, review, correct, and resubmit authorizations as needed.
Clear authorization-related claims edits promptly and in accordance with department and organizational metrics and standards.
Investigate, resolve, and document insurance issues, contacting relevant stakeholders as needed.
Coordinate with contracting to obtain letters of agreement for patients with non-LPCH contracted coverage.
Notify the Authorization Assistant Manager about possible deferrals or denials of elective or non-emergent services that are not approved before the service date.
Communicate with the access nurse and/or appropriate clinician to arrange necessary triage or help resolve insurance issues.
Perform duties in accordance with hospital policies and procedures, Service Standards, Code of Conduct, and applicable Joint Commission requirements.