Senior Coordinator - PAVE

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The Sr. PAVE Coordinator is responsible for initiating pre-authorization requests to the payer for claims that require approval. This position requires communication with payers, patients, physician offices and hospital clinical staff. It is primarily responsible for pre-certifying procedures ordered by physicians, monitoring appropriateness and medical necessity, and providing necessary information for authorization and continued visits. The Sr. PAVE Coordinator will confirm pre-certifications that have been obtained or will obtain pre-certifications if needed, in addition to conducting quality assurance.

• Serve as primary resource for LH regarding insurance eligibility; prior authorization process and requirements; collect patient demographic information and coverage information. Advise patients of their financial obligation and collect payments in a courteous and professional manner.
• Contacts insurance companies by phone, fax, or online portal to obtain insurance benefits, eligibility, and authorization information.
• Update systems with accurate information obtained; perform quality assurance audits and report back to leadership with opportunities for education to patient access.
• Communicate to service line partners about situations where rescheduling is necessary due to lack of authorization or limited benefits, as approved by clinical personnel.
• Ensure proper authorization is in place for inpatient, elective, outpatient, surgical, urgent/emergent services; notify payers of the patient’s visit to the facility to protect the financial standing of the organization. Escalate non-authorized accounts/visits to management.
• Document all benefits (copays, deductibles, co-insurance, OOP, LTM), authorizations, pre-certifications, and patient financial obligations clearly and accurately to expeditiously process patient accounts and prevent denials.
• Maintain a close working relationship with clinical partners and ancillary departments to ensure open communication between clinical, ancillary, and Patient Access & Patient Financial Services, Surgical Scheduling, Case Management, and Utilization Review to support authorization requests to payers.
• Monitor team mailbox, e-mail, faxes, and phone calls, responding to all related PAVE account issues within defined time frames; adhere to department accuracy and performance standards.
• Contact payer to obtain prior authorization and gather additional clinical or coding information as necessary.
• Provide standardized documentation within the system to identify prior authorization and the criteria; verify that all insurance requirements have been met; notify patient, provider’s office, scheduling, and financial counselor immediately when insurance coverage is inadequate or terminated.
• Advise providers and their clinical staff when issues arise relating to obtaining prior authorization; educate providers and their clinical staff regarding the prior authorization process.
• Stay informed and research information regarding insurance criteria for prior authorization; attend department meetings, professional education sessions, complete e-learnings and mandatory training.
• Performs other duties as assigned by PAVE Leadership.

• Minimum three (3+) years of experience in Medical Billing, Hospital Patient Access, or Hospital Business Office in an automated setting.
• Knowledge of registration, verification, pre-certification, and scheduling procedures.
• Experience with Medical and Insurance terminology (ICD-10, CPT
  4).
• Minimum of one (1+) year of demonstrated strong analytical skills.
• Proficiency with Microsoft Office and Outlook.
• Excellent verbal and written communication skills.
• Preferred experience with the Epic Hospital Billing System.
• Bachelor’s Degree in Accounting, Finance, Business Administration or Healthcare related field preferred.
• Minimum three (3+) years of Revenue Cycle Experience in lieu of degree.

• One (1+) or more certifications from AAHAM, NAHAM or HFMA required.
• Healthcare Certification
• CRCE - Certified Revenue Cycle…