Insurance Authorization Coordinator I

The Nemours Foundation•Pensacola, FL

10d

About The Position

The Insurance Authorization Coordinator I is responsible for obtaining authorizations for hospital-based and/or physician-based services. The Coordinator utilizes work queues & other mechanisms to initiate the authorization and/or referral, follow-up, monitor appointments add-ons, and document any changes available for the initial authorization and/or referral request. Authorizations/Referrals for services are to be completed based on the departmental goals and guidelines set. The position is required to utilize all available resources to verify eligibility, authorization requirements and plan benefit levels. Detailed benefit collection process to ensure capture of patient responsibility to include all financial out to pocket cost to patient/parent. Process supports and ensures more accurate financial collections.

Requirements

One year of specialized training beyond high school
Minimum of 6 months Insurance Authorization experience required

Responsibilities

Request and obtain preauthorization for assigned specialties and ability to cover for other workflows including workqueue items.
Submit required documentation, follow up on requests to ensure timely approvals.
Ensure requests for authorizations and notifications are worked timely and handled in accordance with departmental policy and payer requirements.
Follow all documentation requirements.
Verify patients’ insurance coverage, eligibility, demographics, benefits and financial responsibility to determine if prior authorization is required for specific medical procedures or treatments; additionally any predetermination requirements to ensure proper payment for service to support collection accuracy & efforts.
Stay up to date with insurance policies, guidelines, and procedures related to authorization and reimbursement processes.
Understand specific requirements for different insurance companies and their medical coverage policies.
Properly process appointment or appt add-ons, changes to previously scheduled services, date changes, and or impactful service changes in need of immediate review.
Follow administrative review process if a service does not have an insurance authorization outside of the department’s standard timeframe.
Communicate with patients, their families, and healthcare professionals to provide updates on the status of authorization requests, address questions or concerns, and ensure a smooth process for all parties involved.
Promptly review clinical documentation for necessary information to submit to the payer along with authorization request.
Maintain accurate and detailed records of authorization requests, approvals, denials, and any related correspondence.
Document patient information, insurance details, and the authorization process itself.
Collaborate with healthcare providers, physicians, and clinical staff, additionally the Central Business Office, Financial Services, Transport, Patient Cost Estimation, Managed Care, Utilization Review, dedicated Authorization Departments, and other departments that have impact on obtaining authorizations and/or reimbursement.
Identify and address any barriers or challenges that may arise during the authorization process.
Work with insurance companies to resolve denials, appeal decisions, or find alternative solutions for patients’ medical needs.
Attend and participate in daily departmental huddles to report on payer issues, barriers affecting workflows, and specific issues that could result in a non-reimbursable or canceled service.
Be organized, work effectively in a virtual team environment, problem solve, and seek assistance when needed.
Build and maintain professional, cooperative relationships with contacts from specialty departments.
Consistently demonstrate excellent, empathetic, and knowledgeable customer service skills to internal and external customers.
Adhere to relevant laws, regulations, and privacy guidelines when handling patient information and insurance-related documentation.
Ensure all authorization processes are conducted ethically and in accordance with organizational policies.