Healthcare PreAuthorization Coordinator

Westside Family Healthcare•New Castle, DE

9d•Onsite

About The Position

WESTSIDE IS LOOKING FOR A PREAUTHORIZATION COORDINATOR TO JOIN THE TEAM! JOIN THE TEAM THAT MAKES A DIFFERENCE! Westside Family Healthcare is a nonprofit organization that provides high quality primary medical care without regard to ability to pay. The Preauthorization Coordinator processes prior authorizations and insurance referrals for specialty care, imaging and diagnostic testing for Westside Family Healthcare (“Westside”) patients, systematically supporting patients, providers and healthcare coordinators working with medical neighbors to coordinate care. Since opening our doors in 1988, Westside has been driven by our mission to improve the health of our communities by providing equal access to quality healthcare. With 240 team members, five health centers, one mobile health unit and over 27,000 patients all across Delaware, Westside is committed to improving health, one patient, one family, one community at a time. WORKING AT WESTSIDE MEANS WORKING IN A PRIMARY CARE MEDICAL HOME A Primary Care Medical Home is not a special building. It is a way to provide healthcare that puts the patient at the center of health care decision-making. As a community health center, Westside Family Healthcare provides care for everyone who walks through our doors. Our Mission: To improve the health of our communities by providing equal access to quality healthcare Our Vision : Achieve health access for all Our Values: Compassion: Lead with compassion Service: Serve with humility Excellence: Be exceptional Empowerment: Empower all people

Requirements

High school diploma or GED
One year of work experience in the medical or health insurance field
One year of experience using Microsoft Office software
One year of experience using electronic medical record software
Knowledge of CPT, ICD 10 codes and medical terminology
One year of experience processing prior authorizations and insurance referrals

Responsibilities

Use web, phone and fax to process prior authorizations and insurance referrals for specialty care, imaging and diagnostic testing for all Westside patients, including out-of-network specialists and facilities.
Procure necessary documentation from the patient’s electronic medical record and local health information technology partners.
Document all interactions with patients, providers, payers, and other individuals on behalf of patients clearly, thoroughly and accurately in the patient’s medical record.
Communicate with Westside providers promptly when the insurance company requires a peer review.
Monitor and respond promptly to inbound calls and / or correspondence and documents related to prior authorization of patient care.
Maintain a working knowledge of prior authorization requirements by monitoring all payer websites/portals and communications.
Communicate with the billing department when a PCP change occurs as a result of the preauthorization process.
Perform data collection related to prior authorizations and insurance referrals, as assigned.
Follow organizational guidelines regarding the use of the Electronic Medical Record (EMR) in compliance with HIPPA and patient confidentiality standards.