Authorizations Coordinator

Woundlocal•Austin, TX

About The Position

Respond to incoming referrals, verify demographic information, and referral requirements to assess the organization's ability to meet patient needs prior to services. Coordinate referrals between Primary Care Providers and specialists to ensure all referrals meet payer-specific guidelines (e.g. HMO, WellMed, Medicare Advantage plans) Work with insurers to verify patient eligibility and benefits, and expediently complete prior authorizations using insurance portals or calling insurers directly. Ensure authorization is approved in a timely manner by following up with insurers and providing additional information Collaborate with billing department on account updates and authorization activity. Review authorizations to ensure proper coding (including modifiers) and coverage. Assist with denials by obtaining clinical information, ICD-10 coding, or other details to correct errors. Be responsible for handling multiple prior authorizations simultaneously and create processes to ensure top of the line performance. Conduct courtesy follow-ups, participate in training, and ensure compliance with policies and values. Maintain charts, records, and databases of patient referral authorizations Understand specialty-specific workflows, including creating re-authorizations, prior authorizations, etc Become a subject matter experty in woundcare prior authorization workflows for large all insurers. Communicate with referral sources, patients, and internal teams to resolve issues and provide alternative resources when needed. Stay informed on authorization requirements for all payors and regulatory guidelines Why this job is AWESOME: Join us and you will see…we don’t do things like everyone else. We are the newest and fastest growing in popularity for mobile healthcare servicing long-term care facilities. It’s no secret how we're accomplishing this… it’s our incredible team members and the winning culture we’re building! If you are looking for an amazing practice to work for, grow, learn, and have a blast - this is it. Great team! We spend a ton of time hiring and training the best people. Great pay! We pay very well. Great opportunities! We're growing and we like to promote from within. If you're a true rock star, the opportunities are limitless!

Requirements

High School Diploma or GED required
1-3 years of billing and/or accounts receivable experience
Strong knowledge of payer guidelines related to HMO, WellMed, PPO, and Medicare Advantage plans.
Strong understanding of processes for prior authorization of referrals
Attention to detail and excellent organizational skills
Familiarity with payer websites and billing resources
Basic medical coding/terminology and insurance practices
Proficiency in MS Office and ability to learn agency-specific software
Solid phone communication with empathy, patience, and professionalism
Ability to work independently, manage time effectively, and quickly learn program structures and procedures.

Responsibilities

Respond to incoming referrals, verify demographic information, and referral requirements to assess the organization's ability to meet patient needs prior to services.
Coordinate referrals between Primary Care Providers and specialists to ensure all referrals meet payer-specific guidelines (e.g. HMO, WellMed, Medicare Advantage plans)
Work with insurers to verify patient eligibility and benefits, and expediently complete prior authorizations using insurance portals or calling insurers directly. Ensure authorization is approved in a timely manner by following up with insurers and providing additional information
Collaborate with billing department on account updates and authorization activity. Review authorizations to ensure proper coding (including modifiers) and coverage. Assist with denials by obtaining clinical information, ICD-10 coding, or other details to correct errors.
Be responsible for handling multiple prior authorizations simultaneously and create processes to ensure top of the line performance. Conduct courtesy follow-ups, participate in training, and ensure compliance with policies and values.
Maintain charts, records, and databases of patient referral authorizations
Understand specialty-specific workflows, including creating re-authorizations, prior authorizations, etc
Become a subject matter experty in woundcare prior authorization workflows for large all insurers. Communicate with referral sources, patients, and internal teams to resolve issues and provide alternative resources when needed.
Stay informed on authorization requirements for all payors and regulatory guidelines