Authorization Coordinator WFH Job Bartlett Tennessee USA,Healthcare

Experience the HCA Healthcare difference where colleagues are trusted, valued members of our healthcare team. Grow your career with an organization committed to delivering respectful, compassionate care, and where the unique and intrinsic worth of each individual is recognized. Authorization Coordinator WFH

Job Summary and Qualifications
The Authorization Coordinator is responsible for timely and accurate processes associated with some or all of the following job duties; pre-certification, obtaining and certifying authorizations, assisting with appeals of authorizations. Additionally, collaborates with the referral coordinator to ensure that all approvals are obtained.

What you will do in this role:

Responsible for review and completion of prior authorizations to ensure timeliness of appointments, testing, procedures, and claims filing.

Obtain clinical information (including but not limited to medical history, diagnosis, and any relevant lab reports) necessary to complete the Prior Authorization to include insurance requirements.

Follow the criteria for all services requiring prior authorizations and submit requests in a timely manner. Ensure appropriate documentation is entered into the standard billing system. Ensuring that this documentation entry is performed in all needed systems.

Tracks status of prior authorizations via payor authorization portals

Reviews denied claims for clinical accuracy, corrects errors for claims resubmission.

Clearly support patient experience through patient-centered communications demonstrating excellent customer service skills

Communicate with insurance companies to pre-certify/authorize/amend services

Recommend new approaches, policies, and procedures to influence continuous improvements in department’s efficiency and services performed

Actively participate in problem identification and coordinates resolution between appropriate parties

Utilize appropriate communication system to facilitate communication with hospital partners

Ensure appropriate documentation is entered in standard format in billing system. This should be performed in the applicable Health Information System (i.e. Source systems) and if necessary, any other subsidiary systems if they are not automatically updated. — Is this redundant from bullet three? Could probably combine this one and bullet three into one statement.

Research Patient Visit History to ensure compliance with payor specific payment window rules; appropriately communicate patient payment responsibilities and guide them through needed steps.

Performs other related job functions as assigned

Practice and adhere to the Code of Conduct and Mission, and Value Statements.

What Qualifications you will need:

EDUCATION:

High School Diploma or GED equivalent required

EXPERIENCE:

One year of related experience with medical insurance plans and/or Medicare benefits verification required.

One-year medical clinic, urgent care, or hospital care setting experience preferred

Prior Authorization experience preferred

CERTIFICATION/LICENSE:

None required

Work from Home, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services
Wellbeing support, including free counseling and referral services
Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence
Savings and retirement resources
, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover…