Prior Authorization Coordinator

Authorization Coordinator

GENERAL DESCRIPTION:

The Authorization Coordinator’s primary function is to verify eligibility and obtain Prior Authorization for procedures / services performed in the clinic, i.e., CT scans and return office visits, and for services to be performed at outside facilities, i.e., radiology and specialty referrals. The job requires knowledge of insurance plans and types, as well as an understanding of the referral/authorization process. Primary skills include high degree of organization and interpersonal skills in order to interact with patients, physicians and co-workers.

EXPERIENCE ANDSPECIFIC SKILLS REQUIRED:

The Authorization Coordinator should have the following skills; knowledge of insurance plans and types; knowledge of CPT and ICD-10 coding; knowledge of authorization and medical record documentation requirements in reference to billing. Position requires excellent communication skills, ability to interact with co-workers as well as patients and a pleasant attitude. Job requires attention to detail and a working knowledge of computers and other business office machines.

Primary Job Duties:

1. Verify eligibility and benefits of patients requiring in-office procedure or office visit. Explain benefits to patients waiting to obtain same day services as requested. Communicate delays to physicians / medical assistants.

2. Request and obtain authorization from insurance companies for in-office procedures, i.e., CT scans, surgical services scheduled in the procedure room or return office visits and outside services, i.e., radiology, specialty office referrals, etc. Utilize the NextGen EPM / EHR software system to obtain authorization requests from the physician / medical assistant. Maintain a paper record of the authorizations in process, i.e., pending review, awaiting a Peer to Peer phone call, etc. Complete the authorization fields of the order entry process in the NextGen EHR patient chart. Initiate all authorizations in date order received unless notified by a physician / medical assistant that an authorization request is considered urgent and should take priority over authorization requests submitted previously.

3. Make follow up inquires via phone calls or insurance company websites to ensure proper authorization is in place prior to services being rendered.

4. Communicate delays to physicians, medical assistants and patients; reschedule appointments as needed due to pending or denied authorization requests.

5. Request retroactive authorizations as required; communicate retroactive authorization information to the billing office staff as needed.

6. Record concise and accurate notes in medical record/chart. Obtain hard copy of authorization; scan authorizations to the NextGen EHR chart; stamp hard copy authorizations with the SCANNED stamp then forward hard copies to the medical records department.

7. Notify physician if procedure cannot be performed in the office due to pre-certification or contractual requirements. Follow up as needed on pending authorization requests.

8. Create a daily CT scan report from the Xoran website, http://ent00074svr/default.asp; ensure that all CT scans performed in the office each day have an authorization generated as required by the patient’s health plan; attempt to obtain a same day retroactive authorization when necessary.
9. Report any system or health plan specific problems, i.e., health plan contractual changes, website problems, etc., to management as soon as possible to ensure speedy resolution.

10. Assist in training new employees as needed.

11. Attend scheduled monthly/quarterly department staff meetings.

Position Specifications:

1. Must meet Office requirements for employment.

2. Must have experience with processing authorizations and knowledge with insurance.

3. Must have a private workspace to work remotely.

Education:

1. High School diploma or equivalent.

Job Type: Full-time

Pay: $18.00 - $22.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Weekly day range:

• Monday to Friday

Work Location: Hybrid remote in Mission Viejo, CA 92691