Insurance Authorization Coordinator

Conifer Health Solutions•San Antonio, TX

11d•Onsite

About The Position

The individual in this position works under the direction of an RN Case Manager and/or Social Worker. Responsibilities include following up on patient accounts requiring authorization for stay, faxing clinical reviews, monitoring accounts during the stay and upon discharge for authorization, documenting in the electronic system, escalating potential disputes or denials to the Director of Case Management, trending disputed claims by payor and physician, and assisting in obtaining authorization for patients discharged to facilities requiring authorization. Other duties as assigned.

Requirements

High school diploma or equivalent required
Excellent organizational skills
Excellent verbal and written communication skills
Demonstrated problem solving skills
Computer literacy

Nice To Haves

Associate or Bachelor’s degree
Acute hospital experience
Data Analytic skills
Paramedic, EMT or Nursing Assistant certification/licensure

Responsibilities

Follow up on patient accounts when authorization for stay is required, Fax numbers to Send clinical reviews
Follow up on each account during the stay and on discharge for authorization - document in the electronic system
Escalate any potential disputes or denial of accounts to Director of Case Management or designee
Trends disputed claims by at least payor and physician
Assist in obtaining authorization for patient discharged to Skilled Facilities or other post-acute care that require authorization
Other duties as assigned
Validates patient’s demographic and payer information with patient/family and notifies Patient Access immediately if any corrections are needed
Validates that all commercial/managed care discharges have an authorization for status and level of care provided and notifies Director of Case Management (DCM) or designee of variances
Cases that require authorization are obtained daily by fax or phone and documentation is completed daily
Escalate discharged cases at end of day that have no authorization or notification of dispute is provided by payor
Concurrently make sure all clinical needed by payors and updates are provided by alerting Case Manager assigned to case and escalating to DCM if not completed timely
Trend dispute/denial potential to DCM or designee by failure points in revenue cycle
Prepare denial information for UR Committee, Denial and Revenue Cycle Meetings
Collaborate with Patient Access, Case Management, Managed Care and Business office to improve concurrent review process to avoid denial or process delays in billing accounts (85% daily, essential)
Follow up on Authorization for post-acute services
Makes referrals for post-acute services under the direction of the RN Case Manager or Social Work (SW) staff utilizing the Tenet Case Management documentation system
Follow-up if referral requires an authorization by payor to discharge the patient
Completes tasks as assigned by RN or LVN Case Manager and/or SW staff
Makes copies, send faxes and complete phone calls to arrange post-acute services and to ensure that appropriate hospital information is communicated to post-acute providers
Documents all referrals and tasks in the Tenet Case Management documentation system per Tenet policy
Provides Important Message follow up letter to Medicare beneficiaries per Tenet policy and under the direction of the RN Case Manager or SW (10%daily, essential)
Adheres to federal, state, and local regulations and accreditation requirements impacting case management scope of services
Adheres to department structure and staffing, policies and procedures to comply with the CMS Conditions of Participation and Tenet policies (5% daily, essential)