Authorization Coordinator

DRISCOLL HEALTH PLAN•Corpus Christi, TX

1d•Onsite

About The Position

Using the EPIC EMR system, the Authorization Coordinator is responsible for working with nursing staff and patients’ families to schedule surgeries. This role involves verifying insurance and hospital coverage for all patients and facilitating the necessary authorizations for both inpatient and outpatient benefits. The individual will also ensure all required surgical clearances (cardiac, neurological, and pulmonology) are obtained prior to surgery. This position acts as the primary liaison between Driscoll Children’s Hospital’s operating room, physicians, and/or their designees regarding the scheduling of all surgical procedures, ensuring fair and even administration of scheduling rules for elective surgical procedures. Additionally, the Authorization Coordinator serves as a liaison between families and the hospital financial coordinator when families lack insurance for patients who urgently need surgery.

Requirements

High school diploma or general education degree (GED)
Two to three years related experience and/or training in medical field
Equivalent combination of education and experience

Nice To Haves

Experience with EPIC EMR system

Responsibilities

Maintains utmost level of confidentiality at all times.
Adheres to hospital policies and procedures.
Calls insurance companies for pre-certifications requirements.
Calls Pharmacy for prior authorization for medications, specialty drugs and biologic meds.
Obtains prior authorizations for both in-patient and outpatient services for all patient cases.
Ensures that patients that require surgical clearances are obtain prior to the scheduled surgery.
Ensure that all medications that need prior authorization are done and ready for the patients surgery.
Coordinates and works with DME companies for any devices which require authorization.
Ensure that home health is coordinated prior to patient discharge as necessary.
Coordinates schedules with outside vendors that support the physicians including Plastics & Dermatology for any surgeries that require such services.
Coordinates surgeries with other surgeons including Plastic Surgery, ENT, Urology, Orthopedics & Neurosurgery for patients that require multiple services.
Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.
Inputs appropriate data necessary for proper and accurate scheduling of elective surgical procedures.
Ensures thorough schedule management that optimizes utilization of elective surgical time and surgical equipment.
Maintains and updates the EPIC surgical scheduling system.
Troubleshoots problems with scheduling system and identifies / implements corrective actions.
Obtains consent signatures of parents/guardians for hospital surgical consents.
Communicates with OR Manager, OR Scheduler, Nurse Coordinator, and Clinic Director for problem resolution or to provide information of pending issues.
Provides admitting physicians and/or consultants with appropriate patient information and insurance benefits.
Adheres to current scheduling policies & procedures and ensures even and fair application of policies and procedures for all physicians utilizing DCH’s operating room.
Uses appropriate communication and interpersonal skills to facilitate problem resolution.
Assist families coordinate their over nights stays with lodging at the Ronald McDonald House, hotel reservations, transportation and immigrations letters to travel for their child’s surgery.
Cancel and/or Reschedule surgeries as necessary.
Performs other duties as needed and assigned.