Coordinator - Prior Authorization Verification and Eligibility

Luminis Health • Annapolis, MD

1d • $18 - $26 • Onsite

About The Position

The PAVE Coordinator is responsible for initiating Pre-Authorization requests to the payer for claims that require approval. This position requires communication with payers, patients, physician offices, and hospital clinical staff. The primary responsibility is to pre-certify procedures ordered by physicians. The PAVE Coordinator will also monitor appropriateness and medical necessity, providing necessary information for authorization and continued visits. This individual will confirm pre-certifications that have been obtained or will obtain pre-certifications if needed, in addition to conducting quality assurance.

Requirements

• Minimum two (2+) years of experience in Medical Billing, Hospital Patient Access, or Hospital Business Office in an automated setting.
• Knowledge of registration, verification, pre-certification, and scheduling procedures.
• Experience with Medical and Insurance terminology (ICD-10, CPT 4)
• Minimum of one (1+) year of demonstrated strong analytical skills
• Proficiency with Microsoft Office and Outlook
• Excellent verbal and written communication skills.

Nice To Haves

• Preferred experience with the Epic Hospital Billing System
• Associates Degree Accounting, Finance, Business Administration or Healthcare related field preferred
• Minimum two (2+) years of Revenue Cycle Experience in lieu of degree
• 1 or more Certifications preferred: CRCE - Certified Revenue Cycle Executive, CRCP- Certified Revenue Cycle Professional, CRCS- Certified Revenue Cycle Specialist, CHAM – Certified Healthcare Access Manager, CHAA- Certified Healthcare Access Associate, CHFP- Certified Healthcare Financial Professional, CRCR- Certified Revenue Cycle Representative

Responsibilities

• Serve as primary resource for LH regarding insurance eligibility; prior authorization process and requirements; collects patient demographic information and coverage information. Advises patients of their financial obligation and collects payments in a courteous and professional manner.
• Contacts insurance companies by phone, fax, or online portal to obtain insurance benefits, eligibility, and authorization information.
• Updates systems with accurate information obtained; performs quality assurance audits and reports back to leadership opportunities for providing education to patient access.
• Responsible for communicating to service line partners of situations where rescheduling is necessary, due to lack of authorization or limited benefits and is approved by clinical personnel.
• Ensures that proper authorization is in place for inpatient, elective, outpatient, surgical, urgent/emergent services and held responsible for timely notification to payers of the patient’s visit to the facility to protect financial standing of the organization. Escalates non-authorized accounts/visits to management.
• Ensures all benefits (Copays, Deductibles, Co-Insurance, OOP, LTM), authorizations, pre-certifications, and financial obligations of patients, are documented on account, clearly, accurately, precise, and detailed to ensure expeditious processing of patient accounts and denial prevention.
• Maintains a close working relationship with clinical partners, and ancillary departments to ensure continual open communication between clinical, ancillary, and Patient Access & Patient Financial Services, Surgical Scheduling departments. Case Management, and Utilization Review to facilitate the sending of clinical information in support of the authorization to the payer, as assigned.
• Monitors team mailbox, e-mail inbox, faxes, and phone calls responding to all related PAVE account issues, within defined time frames; Adheres to the department accuracy and performance standards.
• Contact payer to obtain prior authorization. Gather additional clinical and or coding information, as necessary, in order to obtain prior authorization.
• Provide standardized documentation within system to identify prior authorization and the criteria surrounding such authorization; Verify that all insurance requirements have been met; Notify patient, Provider’s Office, Scheduling and Financial Counselor immediately when insurance coverage is inadequate or has been terminated.
• Advises providers and their clinical staff when issues arise relating to obtaining prior authorization; educate providers and their clinical staff regarding the prior authorization process.
• Stay informed and research information regarding insurance criteria for prior authorization; Attend department staff meetings, professional education sessions, complete e-learnings and mandatory training.
• Performs other duties as assigned by PAVE Leadership.

Benefits

• Medical, Dental, and Vision Insurance
• Retirement Plan (with employer match for employees who work more than 1000 hours in a calendar year)
• Paid Time Off
• Tuition Assistance Benefits
• Employee Referral Bonus Program
• Paid Holidays, Disability, and Life/AD&D for full-time employees
• Wellness Programs
• Employee Assistance Programs

What This Job Offers

• Career Level: Mid Level
• Education Level: Associate degree