Patient Access Coordinator (Pre-Authorization) - Temporary

Agendia Inc.•Irvine, CA

20h

About The Position

AIM OF THE POSITION The Patient Access Coordinator is responsible for requesting authorization for all applicable incoming orders. This process includes understanding of payers’ medical policies for our services, collecting and reviewing all the necessary documentation required to submit prior authorization, contacting the ordering physician or their office for additional information if applicable, completing the required authorization submission forms within allotted timeframes and, follow-up with the payor to obtain an authorization determination. When applicable, the PA Coordinator will also submit a Prior Authorization appeal if criteria is met but the PA was denied erroneously. POSITION WITHIN THE ORGANIZATION 1. Customer Care, Sales, Commercial and external vendors 2. Cooperates with all departments across the organization

Requirements

High School diploma or general education degree
1 + years related experience preferable
Medical Pre-Authorization knowledge/experience 1 + years
Knowledge of CPT and ICD 10 codes
Ability to read and understand medical payer policies as well as pathology reports
Ability to work with sensitive and confidential information
Must be able to work in a fast-paced environment
Must have strong organizational skills and attention to detail
High degree of accuracy
Manage Multiple tasks independently
Excellent problem resolution
Excellent customer service skills
"Outside the Box" thinker
Other Skills necessary: Analytical thinking, thoroughness, good research skills, and strong verbal/written communication.

Nice To Haves

Previous medical billing experience preferred

Responsibilities

Reviews incoming orders to determine if authorization is required
Reviews documentation from ordering physician for completeness to meet the medical policies of payors and work them in priority dependent on allotted timeframes per payer as the time can vary.
Contacts ordering physician's office to obtain missing documentation when applicable or to meet timeliness of the submissions
Communicate with physician offices and/or sales team for assistance with authorization submissions, when applicable
Verifies diagnosis code on order in line with current ICD 10 requirements
Completion of authorization forms via paper or online
Submit authorizations to payors via fax, through payor portal, or third party vendor with all required documentation to maximize success in achieving approvals
Log authorization actions within the billing system for tracking
Follow up on all open authorization submissions including those submitted by the third party vendor
Notify billing staff and document account when authorization determination is received
Additional tasks as needed