Authorization Coordinator

Catholic Health•Melville, NY

1d•Onsite

About The Position

The Financial Clearance Authorization Coordinator is responsible for ensuring a patient’s visit is financially secured, which requires communication with patients, physicians, office staff, clinicians, and insurance companies to obtain and accurately record patient demographic and insurance information. The role performs insurance verification, insurance notification and authorization, patient financial responsibility communication, and other patient access operational activities for the Catholic Health. The Authorization Specialist role is responsible to submit prior authorizations timely, and that required clinical criteria is complete and accurate according to payer requirements. The role will work closely with Utilization Management, Patient Accounts, and other key stakeholders in the revenue cycle to ensure all pertinent patient and insurance information is on file for clinical submission and billing.

Requirements

High School Diploma or equivalent experience required
Must have a comprehensive understanding of insurance pre-certification requirements, contract benefits, and medical terminology.
Work requires the ability to access online insurance eligibility and pre-certification systems.
Must have expertise in insurance, managed care and federal/ state coverage.
Must be customer focused with strong interpersonal skills and courteous with patients, family members, physicians, and staff members.
Must be able to discuss and complete financial arrangements on the estimated patient liability under stressful conditions while maintaining positive patient relations.
Work requires a high level of problem solving skills
Work requires the ability to interpret and execute policies and procedures.
Work requires the ability to ensure the confidentiality and rights of patients and the confidentiality of hospital and departmental documents.
Must be able to demonstrate a working knowledge of personal computers and other standard office equipment
Must demonstrate a positive demeanor, good verbal and written communication skills, and be professional in appearance and approach.
Must be able to handle potentially stressful situations and multiple tasks simultaneously.
Must be able to successfully complete additional job related training when offered.

Nice To Haves

Insurance Verification and Insurance Pre-Certification/Authorization experience preferred.

Responsibilities

Determine whether authorization is required and utilize payer-specific requirements to secure authorization.
Submit prior authorization requests to payers on behalf of the hospital or physician.
Ensure the required prior authorization clinical documents are complete and timely to ensure submissions are complete.
Setup and support Peer-to-Peer reviews between medical directors and physicians.
Coordinate with clinical staff to provide proof of medical necessity.
Utilize WQs and reports, as assigned by management, to ensure completion of financial clearance functions for all in-scope patients.
Confirm and document the patient’s health insurance(s) effective dates, network status, service coverage requirements, and patient liabilities including deductible, coinsurance and co-payment amounts. This may be completed multiple times before, during, and after a patient’s visit/stay.
Use financial estimate process to make patients aware of estimated financial responsibility, collect and document receipt of estimated patient responsibility amounts prior to service, and appropriately refer them to financial counseling when necessary.
Utilize problem solving skills to determine the best course of action to resolve any problems created as a result of insurance coverage or prior authorizations.
Foresee and communicate to management team any significant issues/risks.
Propose innovative ideas and solutions to enhance operational efficiencies.
Maintain knowledge of The Joint Commission and state/federal regulations, laws and guidelines that impact Financial Clearance functions and Patient Access Services.
Comply with Medical Necessity protocols and proper use of Compliance Checker and National and Local Coverage Decisions.
Maintain knowledge of Medicare, Medicaid and third-party payer regulations and hospital charging and collection policies.
Responsible for other duties as assigned.