Authorization Coordinator

Stanford Medicine Children's Health•Palo Alto, CA

3h•$34 - $43•Remote

About The Position

Reporting to the Authorization Assistant Manager and/or Supervisor, the Authorization Coordinator is responsible for providing day-to-day financial clearance of scheduled services assigned to the Authorization department work ques), and serving as a resource for all departments on complex referral / authorization issues for problem resolution. The Authorization Coordinator advises on authorization related questions and is expected to serve as a role model throughout the organization as providing high-quality customer service in accordance with established Hospital PCARES practices and department specific regulations, policies and procedures.

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 functional area.
Knowledge of Medical Terminology.
Knowledge of Medicare, Medi-Cal, Workers Comp, Managed Care (HMO, PPO, POS, etc ), Children's Health Programs (CCS, GHPP, Healthy Families, etc ).

Responsibilities

Act as a patient and family advocate between obtaining necessary information from providers and fulfilling payers' referral/authorization requirements.
Collaborates with corresponding providers and staff members from service sites to promote the success of obtaining referrals and authorizations.
Tracks and notes patient accounts on the authorization status, follow up and payer issues. Assists respective Authorization team members in prioritizing clinically urgent cases and secure authorizations in advance to minimize LPCH's potential financial risks.
Processes and follows-up on authorizations that have denials, peer-to-peer or further medical justification requirements.
Follows-up on and corrects authorizations that require further research, review, or resubmission.
Ensures all authorization claims edits holding claims are cleared timely and effectively in accordance to department and organizational set metrics and authorization standards.
Investigate, resolve and document insurance issues in a timely and efficient manner, and contact corresponding stakeholders (Authorization Management, medical staff, other clinical staff, ancillary departments and administration) as needed.
Facilitates the coordination with contracting to obtain letters of agreements for patients and families who have non-LPCH contracted coverage.
Informs corresponding Authorization Assistant Manager of any possible deferrals / denials of elective / non-emergent service requests that have not been approved prior to service date.
Communicate with access nurse and/or appropriate clinician for necessary triage and/or to help resolve any insurance issues.