Therapy Authorizations Processor

JOB DESCRIPTION TITLE: Authorization Authorizations Processor:

It is our goal to provide the finest Orthopaedic care possible. This philosophy requires that all office staff and providers be sensitive and responsive to patients’ needs and preferences. To ensure that we hire and retain the quality of staff needed for implementing our philosophy of service, we have adopted the following job description for this position. The position requires that the employee be available forty hours per week, and that also the employee be flexible in his/her schedule to provide efficient service for the group. The employee however, will be expected to work no more than five days per week. Many of the responsibilities require that you have a working knowledge of computers and the ability to learn the proper use of the programs utilized in this office, or those that which may be necessary to meet the needs of the practice. The hours, pay scale, and benefits will be defined as agreed upon.

BASIC FUNCTION: Under the supervision of the Authorization Supervisor, the Authorization Coordinator shall provide all responsibilities necessary for the successful operation of the Authorization Department for Arrowhead Orthopaedics.

RESPONSIBILITIES: Work is primarily performed in the Authorization Department located in Arrowhead Orthopaedics’ offices. The duties of the Authorization Coordinator are of high volume, and the quality of duties performed is needed to be at a high level. The employee will come into contact on a daily basis with confidential patient files. The Authorization Coordinator must be able to handle this information with the highest degree of privacy, discretion, and professionalism. The Authorization Coordinator is responsible for accomplishing the duties set forth below:

General Clerical Activities (There may be other duties required of this position not listed below):

1. Verify out patient and inpatient surgery benefits for PPO/Medicare/Private patient.
2. Verify DME benefits for PPO/Medicare/ Private Patients if not able to dispense in office.
3. Request for pre-certification when necessary for Surgeries and DME items.
4. Make sure authorization is in chart for Tri-West patients.
5. Submit for authorization on Tri-West patients for follow-up visits if not in chart.
6. Call patients with surgery deposits.
7. Schedule appointments at outside facilities for out patient diagnostic procedures that can not be done in office/OIC/AASC.
8. Cover HMO Surgery authorization coordinator when she is off work.
9. Answer calls from patients /return messages.
10. Verify EMG/ESI/orthovisc benefits for PPO/Medicare/Private patients.
11. Keeping surgery follow-up log updated.
12. Confirm what outpatient surgeries are able to go to AASC.
13. Handle calls from insurance companies regarding surgery dates.
14. Submit for all DME’s, diagnostic studies, visco supplement injections & Doctor-to-Doctor referrals.
15. Call on a daily basis and follow up on all submitted surgeries for the status of authorization.
16. Extend surgery authorizations for surgeries whose authorization have expired.
17. Coordinate peer to peer calls for physicians.
18. Coordinate the delivery of all visco supplemental injections with third party vendors.
19. Coordinate delivery of DME with multiple vendors.
20. Coordinate the scheduling of all diagnostic studies with multiple third party vendors
21. Coordinate the scheduling of all doctor-to-doctor referrals.
22. Call interpreter to inform him/her of their patient appointments.
23. Check on faxes and keep correspondence current.
24. Perform other responsibilities as maybe called on by the Supervisor.

Skill Requirements: 

1. Education: High school diploma or equivalence

2. The ability to type 40 words per minute.

3. Skill in operating a computer and scanner, as well as software programs including Microsoft Outlook

4. Telephone etiquette, superior customer service, and professional communication skills are required

5. Must be flexible and able to multitask in a stressful setting.

Typical Physical Demands:

1. Requires sitting and walking, with daily occasional stooping, reaching, and bending.
2. Occasional lifting up to thirty pounds.
3. Hearing must be in the normal range for telephone and personal communication.
4. Requires manual dexterity sufficient to operate keyboards and other office equipment.

RELATIONSHIPS: The Authorization Coordinator should observe and conduct the following relationships:

1. The employee shall be responsible directly to the Authorization Supervisor. The employee shall report to the Authorization Supervisor and his/her assignees any progress, reports, requests, concerns, problems, and/or expectations in relation to the responsibilities of the position. Such communication may be verbal or written as deemed necessary by the employee or as directed by Authorization Supervisor or his/her assignee.
2. The employee shall interact with other office and clinical staff in the Practice. Such interactions should be collegial, professional, and contributing to the safety and pleasantness of the work environment at Arrowhead Orthopaedics.
3. The employee shall interact with patients, medical groups, adjustors, nurse case managers, hospitals, and Primary Care Physicians and their offices. Such communication should always reflect the total commitment of the office to quality care and customer satisfaction. All communication should be professional and any unresolved conflicts are to be reported to the Authorization Supervisor.