Insurance Authorization Coordinator

Tenet Healthcare Corporation•San Antonio, TX

About The Position

The Insurance Authorization Coordinator works under the direction of an RN Case Manager and/or Social Worker. The role supports utilization management and transition management by obtaining and following up on payer authorizations for inpatient stays, levels of care, and post-acute services. The coordinator documents authorization activity, referrals, and assigned tasks in the Tenet Case Management documentation system; escalates potential disputes, denials, and delays; and collaborates with Patient Access, Case Management, Managed Care, and the Business Office to help prevent denials and billing delays. The role also supports compliance with applicable regulations, accreditation requirements, CMS Conditions of Participation, and Tenet policies.

Requirements

High school diploma or equivalent.
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 or licensure.

Responsibilities

Validate patient demographic and payer information with the patient or family and notify Patient Access promptly of any corrections needed.
Validate that commercial and managed-care discharges have authorization for the status and level of care provided, and report variances to the Director of Case Management or designee.
Obtain required authorizations daily by fax or phone and document the work daily.
Follow up on accounts requiring authorization during the stay and at discharge, documenting authorization activity in the electronic system.
Escalate discharged cases that lack authorization or payer notification of a dispute by the end of the day.
Alert the assigned Case Manager when clinical information or updates required by payors are needed, and escalate delays to the Director of Case Management.
Trend potential disputes and denials by payor, physician, and revenue-cycle failure points; report findings to the Director of Case Management or designee.
Prepare denial information for Utilization Review Committee, Denial, and Revenue Cycle meetings.
Collaborate with Patient Access, Case Management, Managed Care, and the Business Office to improve concurrent review and avoid denials or billing delays.
Follow up on authorizations for post-acute services and assist with authorizations for patients discharged to skilled facilities or other post-acute care.
Make referrals for post-acute services under the direction of the RN Case Manager or Social Work staff, using the Tenet Case Management documentation system.
Complete assigned tasks for the RN or LVN Case Manager and/or Social Work staff.
Make copies, send faxes, and make phone calls to arrange post-acute services and communicate appropriate hospital information to post-acute providers.
Document referrals and tasks in the Tenet Case Management documentation system according to Tenet policy.
Provide Medicare beneficiaries with an Important Message follow-up letter under the direction of the RN Case Manager or Social Work staff and according to Tenet policy.
Adhere to federal, state, and local regulations, accreditation requirements, department policies and procedures, CMS Conditions of Participation, and Tenet policies.
Perform other duties as assigned.

Benefits

Medical, dental, vision, and life insurance.
401(k) retirement savings plan with employer match.
Paid time off.
Career development and continuing education opportunities.
Health savings accounts and healthcare and dependent flexible spending accounts.
Employee Assistance Program.
Employee discount program.
Voluntary benefits including pet insurance, legal insurance, accident and critical illness insurance, long-term care, elder and childcare, and auto and home insurance.

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