RESPONSIBILITIES AND DUTIES:
Ensure timely verification and validation of authorizations for all Commercial and Managed care inpatients and other services as assigned.- Contacts insurance companies via phone or website to secure authorization.
- Responsible to review all discharged managed care patients for evidence of authorization entry in the Authorization module.
- Obtains missing authorizations within 3 business days of patient’s discharge or in some cases within 7 days of admission.
- Responsible for checking bill hold weekly for pending authorizations.
- Assists with sending delinquent reviews and resending reviews not received by the Payors.
- Communicate effectively, build and maintain professional, cooperative relationships with Case Management and all departments that have direct or indirect impact on obtaining authorizations.
- Maintains analysis of authorization issues, by payer.
- Reports monthly summary for authorization issues to senior leadership.
- Clearly documents all contacts and authorization information for all types of authorizations in the hospital system, complete standardized documentation requirements in expected format.
- Follows established hospital policies and procedures regarding authorization processes.
- Other duties as assigned.