Coordinator, Benefits Eligibility and Prior Authorization

Cardinal Health

5d•$21 - $26

About The Position

We believe in the power of community oncology to support patients through their cancer journeys. As an oncology practice alliance comprised of more than 100 providers across 50 sites, Navista provides the support community practices need to fuel their growth—while maintaining their independence. What Revenue Cycle Management (RCM) contributes to Cardinal Health Practice Operations Management oversees the business and administrative operations of medical practices. Job Purpose: Revenue Cycle Management focuses on a series of clinical and administrative processes that healthcare providers utilize to capture, bill, and collect patient service revenue. The revenue cycle shadows the entire patient care journey and begins with patient appointment scheduling and ends when the patient’s account balance is zero. This position is responsible for reviewing the physician’s daily schedule and obtaining verification of patients’ insurance benefits for their scheduled visits. They will also obtain authorization for all requested procedures, tests, drugs, etc. The Coordinator, Benefits Eligibility and Prior Authorization may be asked to perform other duties if necessary and must be knowledgeable in a variety of Insurance Plans and Procedures.

Requirements

High School Diploma or equivalent preferred.
2-3 years of prior authorization experience preferred.
Experience with payor websites and authorization requirements.
Strong customer service background, preferably in health care environment.
Excellent verbal communication skills.
Competence with computer processing functions and other standard office equipment.
Ability to manage multiple priorities and prioritize multiple tasks in a fast-paced environment.
Ability to work independently with minimal supervision.
Strong organizational skills.
Knowledge of medical terminology.
Familiar with Urology, Chemotherapy and Radiation Billing.
Experience with computerized billing software and interpreting EOBs.
Working knowledge of ICD-9/ICD-10, CPT, HCPCS, and CPT coding.
Experience with GE Centricity.

Nice To Haves

Preferred experience in Oncology billing preferred.
Knowledge of computer/telephony support, preferably in a healthcare environment.
Strong customer service background, preferably in a healthcare environment.
Excellent verbal communication skills.
Competence with computer processing functions and other standard office equipment.
Ability to manage and prioritize multiple tasks.
Ability to calmly and professionally resolve customer issues with diplomacy and tact.
Ability to work independently with minimal supervision.
Strong organizational skills.
Understanding of managed care contracts and fee schedules, including Medicare and Medicaid.

Responsibilities

Verify all new, returning, and annual patient eligibility to confirm insurance status and benefits including patient responsibility such as deductible, out of pocket, copay and coinsurance prior to services rendered.
Communicate with patients, front end staff, physicians & payors as needed to obtain updated insurance and/or clinical information.
Submit authorizations for all internal and external orders including but not limited to radiation, chemotherapy, PET/CT, urology and scans.
Follow up within 48 hours on any existing authorizations that are pending approval.
Ensure proper documentation outlining all steps taken to ensure authorization have been submitted, followed up on and obtained.
Upon approval, enter all authorization information into the billing system and attach confirmation into the EMR.
Take any action necessary for any denials received by the payor to inform the clinician of changes that may need to happen to not delay patient care.
Complete any pre-service appeals to obtain paying approval based on medical necessity.
Communicate effectively with all RCM and clinical staff to ensure appropriate treatment can be provided, claims can be processed accurately and timely payment received.
Maintain a high level of confidentiality for patients in accordance with HIPAA standards.
Utilize CPT coding, ICD-10 coding knowledge to accurately document procedures and diagnoses.
Coordinate with clinical staff to ensure patients are contracted prior to appointments informing them of any treatment schedule changes.
Effectively complete other duties and projects assigned.
Stay up to date on insurance policies, managed care guidelines and relevant healthcare regulations affecting authorization processes.
Regular attendance and punctuality.
Execute all functions of the role with positivity and team effort.