Prior Authorization Coordinator 11:30am- 8pm

RCM Prior Authorization Coordinator position located in Miramar, Florida. Must be able to work on-site, Monday through Friday 11:30am- 8pm. 

• Ensures quality and accuracy of the patient insurance information and that listed certification periods, billing addresses, policy numbers, authorization numbers, etc. are all entered correctly.


• Prioritizes and processes incoming Insurance Verifications and Prior Authorization requests.


• Verify the patient’s Medicaid, private insurance, and self-pay payor sources via telephone, or online systems.


• Obtain 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.


• Obtain information from agencies when necessary to assist with receiving authorizations and re-authorizations from private insurance and all other payor sources.


• Assist other departments and Care Centers in the efficient collection of client and payor information to ensure accuracy.


• Enter all hospice benefit information into Registration Tool and patient accounting system.


• Respond 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.


• Complete 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.


• Update 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.


• Communicate efficiently, effectively, and timely to resolve issues pertaining to the verification and authorization processes.


• Access Medicare's Common Working File (CWF) to verify eligibility in the event a patient has termed coverage with private insurance carrier if applicable.

QUALIFICATIONS

• 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.


• A 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.

EDUCATION

• High School diploma or GED required

SPECIAL INSTRUCTIONS TO CANDIDATES

• EOE/AA M/F/D/V