Healthcare PreAuthorization Coordinator

Westside Family Healthcare Inc•New Castle, DE

9d•Onsite

About The Position

Westside Family Healthcare is seeking a Preauthorization Coordinator to join their team. This role is responsible for processing prior authorizations and insurance referrals for specialty care, imaging, and diagnostic testing for Westside patients. The coordinator will systematically support patients, providers, and healthcare coordinators in coordinating care. Westside Family Healthcare is a nonprofit organization dedicated to providing high-quality primary medical care to all, regardless of their ability to pay. Since 1988, Westside has been committed to improving community health through equal access to quality healthcare. With multiple health centers and a mobile unit serving over 27,000 patients across Delaware, Westside focuses on improving health one patient, one family, one community at a time. Working at Westside means being part of a Primary Care Medical Home, where the patient is central to healthcare decision-making. Westside provides care for everyone who seeks it.

Requirements

High school diploma or GED
One year of work experience in the medical or health insurance field
One year of experience using Microsoft Office software
One year of experience using electronic medical record software
Knowledge of CPT, ICD 10 codes and medical terminology
One year of experience processing prior authorizations and insurance referrals

Responsibilities

Use web, phone and fax to process prior authorizations and insurance referrals for specialty care, imaging and diagnostic testing for all Westside patients, including out-of-network specialists and facilities.
Procure necessary documentation from the patient’s electronic medical record and local health information technology partners.
Document all interactions with patients, providers, payers, and other individuals on behalf of patients clearly, thoroughly and accurately in the patient’s medical record.
Communicate with Westside providers promptly when the insurance company requires a peer review.
Monitor and respond promptly to inbound calls and / or correspondence and documents related to prior authorization of patient care.
Maintain a working knowledge of prior authorization requirements by monitoring all payer websites/portals and communications.
Communicate with the billing department when a PCP change occurs as a result of the preauthorization process.
Perform data collection related to prior authorizations and insurance referrals, as assigned.
Follow organizational guidelines regarding the use of the Electronic Medical Record (EMR) in compliance with HIPPA and patient confidentiality standards.