SUMMARY OF FUNCTIONS
Procedure Authorization Coordinator is responsible for obtaining insurance eligibility and benefits, authorizations and ensuring all required documentation is completed prior to procedures. This role works closely with physicians, procedure schedulers, clinical staff, patients, and insurance companies to minimize delays and ensure timely approvals while maintaining compliance with payer guidelines.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Review procedure schedule workbooks for current date through two weeks out for referral, authorization and eligibility needs.
- Obtain prior authorizations for cardiovascular procedures.
- Verify insurance benefits, eligibility, and authorization requirements.
- Update patient accounts with accurate demographic, insurance, and other required information.
- Contact patients to obtain or verify insurance information as needed.
- Obtain required referrals and prior authorizations by contacting referring providers, primary care providers (PCPs), and health plans as appropriate.
- Submit authorization requests with all required clinical documentation.
- Track pending authorizations and proactively follow up with insurance companies to ensure timely determinations.
- Work closely with providers to obtain additional clinical information when needed.
- Coordinate peer-to-peer reviews between providers and insurance carriers when required and prepare or submit written appeals when appropriate.
- Document all authorization activity accurately within the electronic medical record (EMR).
- Ensure all authorizations are obtained before scheduled procedure dates to prevent cancellations or delays.
- Communicate authorization status to procedure schedulers, physicians, and clinical staff.
- Notify patients of insurance-related issues, authorization delays, or potential financial responsibilities.
- Scan or save referral, authorization, and insurance-related documentation as PDF files and upload them to the patient's electronic medical record (EMR) or ezAccess, as appropriate.
- Maintain spreadsheets or tracking logs for pending authorizations and expiring approvals.
- Collaborate with billing and revenue cycle departments to resolve authorization-related issues.
- Participate in quality improvement initiatives aimed at reducing denials and improving turnaround times.
- Monitor the EMR desktop, email, and other assigned communication channels daily, responding to referral receipts and internal communications within twenty-four (24) hours.
- Notify the ERA Lead of barriers or delays in obtaining referrals or authorizations from insurance carriers or provider offices.
- Collaborate with the ERA Lead to resolve complex referral and authorization issues involving primary care or referring provider offices.
- Review payer guidelines and stay current on authorization requirements and policy updates.
- Communicate changes in insurance carrier or provider office referral and authorization requirements to the ERA Lead.
- Inform ERA Lead of any insurance non-participating with other facilities.
- Participate in educating clinic staff regarding referral, authorization, and eligibility processes as they relate to their job responsibilities.
- Demonstrate excellent written and verbal communication skills while providing exceptional customer service to internal and external customers.
- Maintain professionalism and composure while effectively managing multiple priorities in a fast-paced environment.
- Document all patient interactions and insurance-related activities accurately, thoroughly, and promptly within the patient's medical record.
- Maintains strictest confidentiality and abides by all HIPAA requirements and standards.
- Participation in new hire/annual training is a condition of employment.
- Other duties as assigned.
Pay: $18.00 - $20.00 per hour
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Vision insurance
Work Location: In person
