RCM Coordinator Prior Authorization 11:30am- 8pm

VITAS Healthcare•Miramar, FL

1d•Onsite

About The Position

The RCM Prior Authorization Coordinator position is located in Miramar, Florida. This role requires the ability to work on-site, Monday through Friday from 11:30 am to 8:00 pm. The coordinator is responsible for ensuring the quality and accuracy of patient insurance information, including certification periods, billing addresses, policy numbers, and authorization numbers. They will prioritize and process incoming Insurance Verifications and Prior Authorization requests, verifying patient payor sources (Medicaid, private insurance, self-pay) via telephone or online systems. The role involves obtaining necessary authorizations from private insurance and other payor sources, maintaining compliance with medical record confidentiality regulations, and managing authorization extensions. Clinical judgment-based authorization requests will be referred to the Prior Authorization Supervisor and clinical support staff. The coordinator will also obtain information from agencies as needed, assist other departments with client and payor information for accuracy, and enter hospice benefit information into the Registration Tool and patient accounting system. Responsibilities include responding to inquiries about referrals and authorization status, providing administrative support, completing Payor Information Forms (PIF) and Payor Change Request Forms (PCR) for accurate reimbursement, and updating the Contracting Coordinator on payor information changes. Additionally, they will coordinate with members, providers, and departments to ensure understanding of Prior Authorization, Referral, and Insurance Verification processes, communicate effectively to resolve issues, and access Medicare's Common Working File (CWF) to verify eligibility when necessary.

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.
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.

Responsibilities

Ensures quality and accuracy of patient insurance information, including certification periods, billing addresses, policy numbers, and authorization numbers.
Prioritizes and processes incoming Insurance Verifications and Prior Authorization requests.
Verifies patient's Medicaid, private insurance, and self-pay payor sources via telephone or online systems.
Obtains 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.
Obtains information from agencies when necessary to assist with receiving authorizations and re-authorizations from private insurance and all other payor sources.
Assists other departments and Care Centers in the efficient collection of client and payor information to ensure accuracy.
Enters all hospice benefit information into Registration Tool and patient accounting system.
Responds 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.
Completes 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.
Updates 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.
Communicates efficiently, effectively, and timely to resolve issues pertaining to the verification and authorization processes.
Accesses Medicare's Common Working File (CWF) to verify eligibility in the event a patient has termed coverage with private insurance carrier if applicable.