Career Center

Essential Functions:

1. Authorization Coordination: Ability to request and obtain preauthorization for assigned specialties and ability to cover for other workflows including work queue items. This will involve submitting required documentation, following up on requests to ensuring timely approvals.
2. Ensure request for authorizations and notifications are worked timely and handled in accordance with departmental policy and payer requirements. Following all documentation requirements.
3. Insurance Verification: Verify patients' insurance coverage, eligibility, demographics, benefits and financial responsibility to determine if prior authorization is required for specific medical procedures or treatments; additionally any predetermination requirements to ensure proper payment for service to support collection accuracy & efforts.
4. Policy Knowledge: Stay up to date with insurance policies, guidelines, and procedures related to authorization and reimbursement processes. This includes understanding specific requirements for different insurance companies and their medical coverage policies.
5. Properly process appointment or appt add-ons, changes to previously scheduled services, date changes, and or impactful service changes in need of immediate review.
6. Follow administrative review process if a service does not have an insurance authorization outside of the department's standard timeframe.
7. Communication: Communicate with patients, their families, and healthcare professionals to provide updates on the status of authorization requests, address questions or concerns, and ensure a smooth process for all parties involved.
8. Promptly review clinical documentation for necessary information to submit to the payer along with authorization request.
9. Documentation and Record-Keeping: Maintain accurate and detailed records of authorization requests, approvals, denials, and any related correspondence. This includes documenting patient information, insurance details, and the authorization process itself.
10. Compliance: Adhere to relevant laws, regulations, and privacy guidelines when handling patient information and insurance-related documentation. Ensure all authorization processes are conducted ethically and in accordance with organizational policies.