Authorizations & Eligibility Coordinator

Summary

Under the general administrative direction of the Department Manager, the Authorization Coordinator, is highly skilled in ensuring that pre-authorizationsfor medical procedures are obtained from insurance carriers. These individuals conduct necessary third-partyauthorizationrequests.

Essential Functions

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Verifies patient insurance coverage utilizing phone or online resources

• Submit prior authorizations to insurances in a timely manner

• Ensures all pertinent medical documentation is accurate and present prior to authorization submission

• Follows up with pending authorizations on a regular basis to obtain the current status or if any action needed in order to obtain the authorization approval

• Notify scheduling staff of delays in obtaining authorizations

• Communicates any authorization denials to the appropriate staff

• Handles any discrepancies, errors, or omissions of authorization denials and files appeals when necessary for overturn of adverse decision

• Participates in educational activities and attends regular staff and department meetings

• Exhibit and manage excellent turn-around time in order to ensure timely authorizations

• Consistently work in a positive and cooperative manner with fellow team members

• Demonstrate flexibility to perform duties wherever volume deems it necessary

• Document activities appropriately in process notes

• Complies with applicable CLIA and HIPAA regulations

Skills/Abilities

• Good problem solving and decision-making skills

• Excellent customer service and phone skills

• Strong organizational, judgment, communication and analytical skills

• Ability to multi-task and perform multiple priorities

• Excellent time management, organizational, communication, multitasking and teamwork skills

• Cooperative and professional behavior toward peers, providers and management

• Ability to promote a favorable image with co-workers, department members, providers and, insurance companies

• Ability to make decisions and solve problems

• The ability to contribute in a team environment and/or independently, to provide excellent customer service

• Ability to thrive in a fast-paced environment and prioritize tasks based on importance

• Strong attention to detail, able to produce accurate and high-quality work

• Adaptability, able to adjust the approach to meet changing demands and situations including dealing with diverse people

• Typing skills (40 wpm)

• Ability to keep confidential patient information to oneself at all times, despite the temptation to share

Required Education and Experience

• High school diploma or equivalent

• Basic knowledge of medical terminology required

• At least one year of experience with the insurance authorization process, preferably in the Dermatology field.

• Working knowledge of ICD-10 and CPT coding (preferred)

• Basic knowledge of general administrative and clerical procedures

• Basic knowledge of Microsoft Word, Excel and Outlook

Supervisory Responsibility

This position has no supervisory responsibilities.

Work Environment

This job operates in a fast-paced professional medical office environment supporting multiple offices. This role routinely uses standard office equipment such as computers, phones, photocopiers, and filing cabinets.

Physical Demands

The employee is required to sit and use both hands for typing for extended periods of time; climb or balance; and stoop, kneel, crouch or crawl periodically. The employee must frequently lift and/or move up to 15 pounds and occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.

Position Type and Expected Hours of Work

This is a full-time, non-exempt position. Days and hours of work are Monday through Friday, 8 hours a day shifts.

Travel

This position requires up to 20% travel. Travel to multiple clinic locations, which are located throughout the Inland Empire and surrounding areas, will be required throughout the week, and at times on short notice.

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.