Prior Authorization Coordinator

VITAS Healthcare•Miramar, FL

1d•Hybrid

About The Position

Prior Authorization Coordinator is responsible for benefits eligibility and verifications, ensuring that patients with insurance or payment concerns are handled appropriately and expediently. Obtains initial authorizations and renews all expiring authorizations for services provided. Must be able to work on-site at our Corporate Miramar office, Monday through Friday, 8:30am- 5pm. Hybrid schedule after 90 days of training. Ensures quality and accuracy of the patient insurance information and that listed certification periods, billing addresses, policy numbers, authorization numbers, etc. are all entered correctly. Prioritizes and processes incoming Insurance Verifications and Prior Authorization requests. Verify the patient’s Medicaid, private insurance, and self-pay payor sources via telephone, or online systems. Obtain authorization from private insurance and all other payor sources requiring authorization via telephone, facsimile, or online systems while maintaining compliance to medical record confidentiality regulations. Maints authorizations extension for all patients as appropriate. Refers authorization requests that require clinical judgment to Prior Authorization Supervisor and clinical support staff. Obtain information from agencies when necessary to assist with receiving authorizations and re-authorizations from private insurance and all other payor sources. Assist other departments and Care Centers in the efficient collection of client and payor information to ensure accuracy. Enter all hospice benefit information into Registration Tool and patient accounting system. Respond to calls, emails and other inquiries regarding the status of outstanding referrals and/or authorization information. Provides other administrative support to the department as needed. Complete Payor Information Form (PIF) and Payor Change Request Forms (PCR) when needed for the purpose of meeting payor and client's needs to ensure accurate reimbursement. Update Contracting Coordinator of payor information changes. Coordinates with members, providers and key departments to promote an understanding of Prior Authorization, Referral, and Insurance Verification requirements and processes. Communicate efficiently, effectively, and timely to resolve issues pertaining to the verification and authorization processes. Access Medicare's Common Working File (CWF) to verify eligibility in the event a patient has termed coverage with private insurance carrier if applicable.

Requirements

At least two years of related healthcare Revenue Cycle experience, preferably within registration and financial clearance.
Understanding of medical terminology and clinical documentation.
Clear understanding of the impact insurance verification and prior authorization has on Revenue Cycle operations and financial performance.
Demonstrated knowledge of commercial insurance carriers' guidelines and criteria of verification, authorization and reimbursement.
Demonstrated knowledge of customer service skills when responding to questions and other inquiries from internal and external customers.
Ability to prioritize and manage multiple tasks simultaneously, and to effectively anticipate and respond to issues as needed in a dynamic work environment.
A demonstrated ability to use PC based office productivity tools (e.g. Microsoft Outlook, Microsoft Excel) as necessary; general computer skills necessary to work effectively in an office environment.
Ability to prioritize and effectively anticipate and respond to issues as they arise.
Ability to work weekends as needed.
Completion of high school or basic education equivalency required.

Responsibilities

Ensures quality and accuracy of the patient insurance information and that listed certification periods, billing addresses, policy numbers, authorization numbers, etc. are all entered correctly.
Prioritizes and processes incoming Insurance Verifications and Prior Authorization requests.
Verify the patient’s Medicaid, private insurance, and self-pay payor sources via telephone, or online systems.
Obtain authorization from private insurance and all other payor sources requiring authorization via telephone, facsimile, or online systems while maintaining compliance to medical record confidentiality regulations.
Maintains authorizations extension for all patients as appropriate.
Refers authorization requests that require clinical judgment to Prior Authorization Supervisor and clinical support staff.
Obtain information from agencies when necessary to assist with receiving authorizations and re-authorizations from private insurance and all other payor sources.
Assist other departments and Care Centers in the efficient collection of client and payor information to ensure accuracy.
Enter all hospice benefit information into Registration Tool and patient accounting system.
Respond to calls, emails and other inquiries regarding the status of outstanding referrals and/or authorization information.
Provides other administrative support to the department as needed.
Complete Payor Information Form (PIF) and Payor Change Request Forms (PCR) when needed for the purpose of meeting payor and client's needs to ensure accurate reimbursement.
Update Contracting Coordinator of payor information changes.
Coordinates with members, providers and key departments to promote an understanding of Prior Authorization, Referral, and Insurance Verification requirements and processes.
Communicate efficiently, effectively, and timely to resolve issues pertaining to the verification and authorization processes.
Access Medicare's Common Working File (CWF) to verify eligibility in the event a patient has termed coverage with private insurance carrier if applicable.