Stamford Health
Authorization Coordinator
Stamford Health, Stamford, Connecticut, United States, 06925
Job Description
JOB SUMMARY:
The Authorization Coordinator is responsible for obtaining appropriate insurance pre-certification/preauthorization prior to the provision of scheduled infusion center services or treatments. This is an on-site position, which allows for direct in person communication with patients, staff and providers. He/she is accountable for pre-registering patients in Meditech, verifying insurance eligibility and obtaining authorization as needed from the payer, Additionally, he/she will be the primary on-site liaison in the Infusion Center for referring providers' offices, patient access staff, insurance carriers, as well as patients and other hospital staff regarding insurance pre-certification/preauthorization verification. This position requires strong computer, interpersonal and communication and organizational skills, as well as knowledge of 3rd-party insurance pre-certification/preauthorization policies and procedures. At least 2 years of CPT / HCPCS and ICD-10 coding experience and medical terminology is required. Knowledge of IV drug administration coding and billing is a plus.
MAJOR ACCOUNTABILITIES/CRITICAL RESPONSIBILITIES:Reviews referring physician orders and documentation received for medical necessity against specific insurance protocol requirements for authorization purposes.Proactively reviews infusion schedule in advance and pre-registers patient, obtains insurance verification and/or authorizations for insurance approval for scheduled and urgent infusion services. Documents all authorizations in Meditech,Communicates to infusion center staff and SH pharmacy regarding individual patient plan payer requirements for drugs to be supplied by payer specialty pharmacy for specific patient treatments to assist with tracking shipments and receipt of drug prior to treatment.Actively communicates with infusion center and patient access staff throughout the workday regarding status of pending authorization for scheduled services prior to appointment date (e.g.., communicate need for reschedule and/or cancellation if authorization not received).Actively receives updates from infusion center staff throughout the workday regarding any changes to existing treatment orders or appointment dates (based on established protocols) and reviews current authorization to ensure authorization is still valid. Obtains new authorization as needed. Documents all updates and new authorizations in Meditech.Acts as a direct liaison with referring provider's offices and patients regarding new, changed, or pending insurance authorizations, as well as on-going education of changes in authorization requirements. Requests additional documentation as needed from referring provider offices for authorization.Arranges peer-to-peer reviews as needed for authorization with payer and referring provider.Participates in development of on-going process improvements related to insurance verification, pre-registration, and authorization management processes.Routinely interacts with patients, their representatives, physicians, physician office staff, and others to gather and ensure accuracy of demographic, billing, and clinical information, demonstrating professionalism and respect at all times.Attends scheduled staff meetings, in service education opportunities and participates in continuing education programs. Creates and maintains effective working relationships with employees and staff in the infusion center, pharmacy, other hospital departments and physician offices.Respects and protects the patient's rights to confidentiality and privacy and discloses information only for professional purposes which are in the patient's best interests with full consideration of their legal rights.QUALIFICATIONS/REQUIREMENTS:
High School Graduate or equivalentAt least 2 years medical coding and/or billing backgroundGood PC skills, especially Microsoft Outlook, Word, and Excel.Ability to effectively multi-task and learn/ adapt to new systems and technology.Demonstrates patience, professionalism, and respect consistently for patients, providers and staff.Is dependable, punctual, and works with a high degree of integrity and accountability.Consistently provides high quality customer service.Performs other related duties as assigned or requested to maintain a high level of service.Accepts direction and constructive criticism and responds appropriately.Effectively works as a member or a care team, and communicates effectively with co-workers, supervisors and management regarding any issues or concerns.Complies with departmental and organizational policies and procedures.Completes required continuous training and education, including department specific requirements.Must be able to articulate well in English and possess excellent written and verbal communication skills.Bi-lingual a plusPATIENT POPULATION SERVED:
All age groupsMANUAL SKILLS:
Significant portions of daily assignments involve application of manual skills requiring motor coordination in combination with finger dexterity, (i.e., typing on computer keyboard, use of telephone).PHYSICAL EFFORT:
Duties involve little or no exertion of physical effort. Must be able to sit at a computer for extended periods. May involve lifting supplies or equipment up to 20 lbs.PHYSICAL ENVIRONMENT:
Generally pleasant working conditions. The nature of duties performed presents little or no potential for job related injury.
*We are committed to building an inclusive workplace that values diversity and inclusion and reflects the diversity of the community and patients we serve.
JOB SUMMARY:
The Authorization Coordinator is responsible for obtaining appropriate insurance pre-certification/preauthorization prior to the provision of scheduled infusion center services or treatments. This is an on-site position, which allows for direct in person communication with patients, staff and providers. He/she is accountable for pre-registering patients in Meditech, verifying insurance eligibility and obtaining authorization as needed from the payer, Additionally, he/she will be the primary on-site liaison in the Infusion Center for referring providers' offices, patient access staff, insurance carriers, as well as patients and other hospital staff regarding insurance pre-certification/preauthorization verification. This position requires strong computer, interpersonal and communication and organizational skills, as well as knowledge of 3rd-party insurance pre-certification/preauthorization policies and procedures. At least 2 years of CPT / HCPCS and ICD-10 coding experience and medical terminology is required. Knowledge of IV drug administration coding and billing is a plus.
MAJOR ACCOUNTABILITIES/CRITICAL RESPONSIBILITIES:Reviews referring physician orders and documentation received for medical necessity against specific insurance protocol requirements for authorization purposes.Proactively reviews infusion schedule in advance and pre-registers patient, obtains insurance verification and/or authorizations for insurance approval for scheduled and urgent infusion services. Documents all authorizations in Meditech,Communicates to infusion center staff and SH pharmacy regarding individual patient plan payer requirements for drugs to be supplied by payer specialty pharmacy for specific patient treatments to assist with tracking shipments and receipt of drug prior to treatment.Actively communicates with infusion center and patient access staff throughout the workday regarding status of pending authorization for scheduled services prior to appointment date (e.g.., communicate need for reschedule and/or cancellation if authorization not received).Actively receives updates from infusion center staff throughout the workday regarding any changes to existing treatment orders or appointment dates (based on established protocols) and reviews current authorization to ensure authorization is still valid. Obtains new authorization as needed. Documents all updates and new authorizations in Meditech.Acts as a direct liaison with referring provider's offices and patients regarding new, changed, or pending insurance authorizations, as well as on-going education of changes in authorization requirements. Requests additional documentation as needed from referring provider offices for authorization.Arranges peer-to-peer reviews as needed for authorization with payer and referring provider.Participates in development of on-going process improvements related to insurance verification, pre-registration, and authorization management processes.Routinely interacts with patients, their representatives, physicians, physician office staff, and others to gather and ensure accuracy of demographic, billing, and clinical information, demonstrating professionalism and respect at all times.Attends scheduled staff meetings, in service education opportunities and participates in continuing education programs. Creates and maintains effective working relationships with employees and staff in the infusion center, pharmacy, other hospital departments and physician offices.Respects and protects the patient's rights to confidentiality and privacy and discloses information only for professional purposes which are in the patient's best interests with full consideration of their legal rights.QUALIFICATIONS/REQUIREMENTS:
High School Graduate or equivalentAt least 2 years medical coding and/or billing backgroundGood PC skills, especially Microsoft Outlook, Word, and Excel.Ability to effectively multi-task and learn/ adapt to new systems and technology.Demonstrates patience, professionalism, and respect consistently for patients, providers and staff.Is dependable, punctual, and works with a high degree of integrity and accountability.Consistently provides high quality customer service.Performs other related duties as assigned or requested to maintain a high level of service.Accepts direction and constructive criticism and responds appropriately.Effectively works as a member or a care team, and communicates effectively with co-workers, supervisors and management regarding any issues or concerns.Complies with departmental and organizational policies and procedures.Completes required continuous training and education, including department specific requirements.Must be able to articulate well in English and possess excellent written and verbal communication skills.Bi-lingual a plusPATIENT POPULATION SERVED:
All age groupsMANUAL SKILLS:
Significant portions of daily assignments involve application of manual skills requiring motor coordination in combination with finger dexterity, (i.e., typing on computer keyboard, use of telephone).PHYSICAL EFFORT:
Duties involve little or no exertion of physical effort. Must be able to sit at a computer for extended periods. May involve lifting supplies or equipment up to 20 lbs.PHYSICAL ENVIRONMENT:
Generally pleasant working conditions. The nature of duties performed presents little or no potential for job related injury.
*We are committed to building an inclusive workplace that values diversity and inclusion and reflects the diversity of the community and patients we serve.