Authorization Coordinator - Manchester Region

2 days ago Be among the first 25 applicants

MMH-71 Haynes Street (10627)

Work where every moment matters.

Every day, over 40,000 Hartford Health Care colleagues come to work with one thing in common:
Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut’s most comprehensive healthcare network. The Greater Manchester Region has approximately 2,500 employees. It includes Manchester Memorial Hospital, a 249-bed community hospital, Rockville General, a campus of Manchester Memorial Hospital, a 102-bed facility, a large multispecialty provider group and visiting nurse services. The Greater Manchester Region serves a region of 300,000 people in 19 towns.

This position reports to the Manager, Central Authorization Center and works directly with FCC, ASC scheduling and physician’s offices to ensure all required approvals, precertification/authorizations are in place to proceed with the scheduled patient services for outpatient ancillary departments. Verifies receipt of patient insurance information, including managed care authorizations; follows up to obtain missing patient and/or insurance pre-authorization data as required.

Researches and resolves reasons for insurance and Medicare claim denials, initiates needed code and billing corrections when appropriate to ensure payment receipt for services provided. This position is responsible for monitoring and obtaining all inpatient and outpatient admissions and procedures.

• High School degree required.
• Associate’s degree preferred.

• 2 years hospital or medical office insurance/authorization/precertification/referral work experience.
• 2 years customer service.

• Knowledge of medical insurance and authorization process.
• Current with CPT and ICD-10 Codes.
• Medical terminology knowledge.
• Must have excellent English written and verbal skills, basic computer and keyboard skills for use of the Meditech system.
• Customer service.
• Experience in meeting deadlines in fast paced multitasking environment.

Disclaimer:
Job descriptions are not intended, nor should they be construed to be, exhaustive lists of all responsibilities, skills, efforts or working conditions associated with the job. They are intended to be accurate reflections of the principal duties and responsibilities of this position. These responsibilities and competencies listed below may change from time to time. Eastern Connecticut Health Network reserves the right to change or assign other duties and responsibilities to this position.

• Obtains insurance eligibility and benefits and documents in ADT system (prior to date of service and or upon admission).
• Notify admissions to insurance carriers by various methods: online, telephonically and fax, as needed to ensure notification requirements are met in a timely manner preventing any denials and nonpayment of services.
• Obtains authorizations prior to date of service, working closely with physician offices to ensure authorizations are obtained by 2pm day before surgery/service. Notifies OR Director of any issues of accounts without authorizations and possible cancellations due to no auth obtained.
• Document clearly in ADT system authorizations, issues, etc.
• Works closely with Case Management and Behavioral Health communicating necessary information to ensure authorizations for admissions obtained.
• Monitors authorizations obtained and documents ensuring conditions of notification have been met and denials are prevented.
• Verifies insurance policy benefit information and obtains authorization/precertification prior to the patient’s visit, scheduled surgery, procedure or admission, and/or immediately following the admission.
• Assists in identifying problems and ensures that the insurance is accurate on the patient’s account.
• Assures insurance information and appropriate referrals have been completely and accurately obtained.
• Responsible for eligibility denial management ensuring accurate insurance information by making corrections on patient accounts received from claim rejections or eligibility failures.
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