MEDICAL NECESSITY & AUTHORIZATION COORDINATOR

This role is responsible for obtaining financial authorization prior to services being received. The Authorization Coordinator works closely with insurance companies and clinical staff to secure payment prior to services, thereby increasing cash flow and reducing write-offs and bad debt. The accuracy of these tasks will ensure authorization for high revenue services and secure payment for the health system.

Essential Duties:

This job description is intended to cover the minimum essential duties assigned on a regular basis.  Team members may be asked to perform additional duties as assigned by their leader.  Leadership has the right to alter or modify the duties of the position.

• Assess patient treatment and therapy plans to determine authorization requirements.
• Understands working knowledge and payor requirements for obtaining authorizations.
• Develops relationships with clinical staff and physicians to secure payment for services related to patients therapy and treatment plans.
• Responsible for providing all required medical information to insurance companies as necessary to facilitate the authorization process.
• Works with specialty pharmacies to obtain authorization for prescription medications.
• Assist in educating and acts as a resource to clinicians and support staff regarding authorizations.
• Follow up on insurance determination within specified time frames.
• Coordinates resolution of escalated member or provider inquiries as related to prior authorization or denial of authorization.
• Communicates to clinicians or other medical staff regarding prior authorizations and pre-certifications especially if a medical procedure or medication has been denied authorization.
• Checks for medical necessity or works with operations to determine insurance requirements.
• Verify insurance eligibility and covered benefits by using all electronic systems available or by phone.
• Possess knowledge of financial class requirements regarding registration and insurance requirements.
• Educate the patient as to their financial responsibility. Collect prepayment for hospital services that are not covered by the patient’s insurance, including co-pays, deductibles, or good faith deposits.
• Operate multiple computer applications to register patients, retrieve insurance, financial information and review medical records.
• Serve as a liaison between Patient Access and other departments e.g. Patient Support Services, Pre-Service, Patient Financial Services, physician office staff, etc., to obtain required data or to escalate issues as necessary.
• Work exception accounts held internally or rejected by payers for errors related to authorization.
• Interview patients and/or physician offices for scheduling and pre-registration. 
• Collect accurate demographic and financial information to assist with billing requirements.
• Enter appropriate ICD-10 codes for registration and billing purposes at the point of scheduling and registration.

Specialized Knowledge and Skills: 

• Working knowledge of Health Care Insurance Verification
• Working knowledge of health related software applications, patient accounting, and patient scheduling processes.
• Working knowledge in medical terminology.
• Understanding of ICD-10 and procedural coding.
• Demonstrated excellent interpersonal communication and collaborative skills.
• Excellent customer service experience.
• Strong oral and written communication skills.
• Punctual, prepared and able to meet or beat deadlines.
• Detail oriented and organized.
• Maintains strict adherence to patient confidentiality.
• Working knowledge of EPIC, Passport, and Microsoft Outlook applications, preferred.