Hospital Admissions / Prior Authorization Coordinator
About The Position
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. Under general supervision, handles the complex coordination involved in scheduling patients for surgical procedures and hospital admissions for multiple clinicians. Coordinates with hospitals to get monthly schedule blocks for physicians and selects appropriate times for procedures. Ensures that all necessary documents and preparatory activities have been completed and that pertinent information is sent to the hospital prior to patients' admissions. Keeps current on the policies and procedures of a multitude of current insurance payors and hospitals. Delivers excellent customer service to patients. Serves as an internal resource as needed.
Requirements
- High School Diploma/ GED
- 2+ years of administrative experience (in a medical setting preferred)
- Ability to work onsite 5 days/week for approximately first 60 days for training
- Must be professional with good communication and interpersonal skills
- Must be detail oriented and a self-starter
- Strong task coordination skills with proven ability to multi-task needed
- Ability to handle unexpected situations calmly and effectively
- Must be able to deal effectively with high levels of anxiety and patient emotion surrounding surgical procedures and hospital admissions
- Strong organizational skills and attention to detail needed to avoid issues with scheduling both routine and emergency procedures
- All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
Nice To Haves
- Previous healthcare experience
- Previous EPIC experience
- Knowledge of various types of insurance coverage desirable
Responsibilities
- Coordinates surgical bookings and hospital admissions for multiple clinicians either within the same or across multiple specialties and/or departments. Understands and effectively maneuvers the surgical booking process understanding and following the requirements for each hospital, insurance provider and clinician as well as applicable Atrius Health booking guidelines. Juggles and prioritizes various scheduling needs effectively.
- Schedules patients for hospital admissions and surgical procedures. Coordinates and books operating room time and surgeon's time. Handles any needed rescheduling due to patient or facility conflicts. May work with other HACS and/or Atrius Health departments to resolve scheduling or booking conflicts.
- Interacts with patients throughout the booking process, responding to requests and providing information in a timely and compassionate manner. Ensures patients understand all their pre- and post-operative appointments as well as any necessary testing prior to surgery (e.g., lab or radiology work). Ensures necessary written material accurately reflects these appointments and includes any directions or special instructions in correspondence. Accurately relays information between patients and clinicians, often dealing with high levels of patient frustration or anxiety.
- Completes outside referral documents and obtains prior authorization for admission where applicable. Maintains and utilizes a thorough understanding and knowledge base of the different payors and the coverage they provide for surgeries. Ensures various requirements and procedures needed are met so that procedures can occur with minimal errors from an administrative standpoint. Keeps current with the changes in insurance company policies and procedures.
- Ensures that all necessary documents and preparatory activities have been selected and forwards all pertinent information to the hospital prior to the patient's admission. Works with clinicians and primary care physicians to ensure appropriate pre-operative testing is done and facilitates medical clearance for the needed procedure.
- Proactively ensures necessary information for admissions is available and processed correctly.
- Maintains data and creates documents in electronic tracking system. May draft and type routine correspondence.
- Provides back-up coverage for other clinical support positions within the assigned department when appropriate.
- Sends electronic spreadsheets and updates to internal and external clients.
- Conducts written or verbal follow-up on procedures.
- May send hospital booking information to the coding and compliance department to ensure that all relevant revenue is captured.
- May fax or batch materials for legal tracking purposes.
- Performs other duties as assigned.
- Accesses only the minimum necessary protected health information (PHI) for the performance of job duties. Actively protects the confidentiality and privacy of all protected health information they access in all its forms (written, verbal, and electronic, etc.) taking reasonable precautions to prohibit unauthorized access. Complies with all Atrius Health and departmental privacy policies, procedures and protocols. Follows HIPAA privacy guidelines without deviation when handling protected health information.
Benefits
- Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
- Medical Plan options along with participation in a Health Spending Account or a Health Saving account
- Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
- 401(k) Savings Plan, Employee Stock Purchase Plan
- Education Reimbursement
- Employee Discounts
- Employee Assistance Program
- Employee Referral Bonus Program
- Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
- comprehensive benefits package
- incentive and recognition programs
- equity stock purchase
- 401k contribution
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
