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Coordinator, Pre-authorization Verification

3 months ago

Annapolis, Maryland, United States Luminis Health Full time

Anne Arundel Medical Center

Title:
Coordinator, Pre-Authorization Verification & Eligibility (PAVE)

Department:

PAVE

Reports To:
Supervisor -
PAVE

Cost Center/Job Code:

FLSA Status:
Exempt

Position Objective:

The
PAVE Coordinator is responsible for initiating Pre-Authorization request to the payer for the claims that require approval. This position require communication with payers, patients, physician offices and hospital clinical staff. This position is primarily responsible for pre-certifying procedures ordered by physicians.

The
PAVE Coordinator will also be responsible monitoring appropriateness and medical necessity and provides necessary information for authorization and continued visits.

This individual will confirm pre-certifications that have been obtained or will obtain pre-certifications if needed in addition to conducting quality assurance.


Essential Job Duties:

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

  • Serve as primary resource for LH regarding insurance eligibility; prior authorization process and requirements; collects patient demographic information and coverage information. Advises patients of their financial obligation and collects payments in a courteous and professional manner.
  • Contacts insurance companies by phone, fax, or online portal to obtain insurance benefits, eligibility, and authorization information;
  • Updates systems with accurate information obtained; performs quality assurance audits and reports back to leadership opportunities for providing education to patient access
  • Responsible for communicating to service line partners of situations where rescheduling is necessary, due to lack of authorization or limited benefits and is approved by clinical personnel;
  • Ensures that proper authorization is in place for inpatient, elective, outpatient, surgical, urgent/emergent services and held responsible for timely notification to payers of the patient's visit to the facility to protect financial standing of the organization. Escalates nonauthorized accounts/visits to management;
  • Ensures all benefits (Copays, Deductibles, Co-Insurance, OOP, LTM), authorizations, precertifications, and financial obligations of patients, are documented on account, clearly, accurately, precise, and detailed to ensure expeditious processing of patient accounts and denial prevention.;
  • Maintains a close working relationship with clinical partners, and ancillary departments to ensure continual open communication between clinical, ancillary, and Patient Access & Patient Financial Services, Surgical Scheduling departments. Case Management, and Utilization Review to facilitate the sending of clinical information in support of the authorization to the payer, as assigned;
  • Contact payer to obtain prior authorization. Gather additional clinical and or coding information, as necessary, in order to obtain prior authorization;
  • Provide standardized documentation within system to identify prior authorization and the criteria surrounding such authorization; Verify that all insurance requirements have been met; Notify patient, Provider's Office, Scheduling and Financial Counselor immediately when insurance coverage is inadequate or has been terminated.
  • Advises 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 staff meetings, professional education sessions, complete e-learnings and mandatory training.
  • Performs other duties as assigned by
    PAVE Leadership.

Educational/Experience Requirements:

  • Minimum two (2+) years of experience in Medical Billing, Hospital Patient Access, or Hospital Business Office in an automated setting.
  • Knowledge of registration, verification, precertification, and scheduling procedures.
  • Experience with Medical and Insurance terminology (ICD10, 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
  • Associates Degree Accounting, Finance, Business Administration or Healthcare related field preferred
  • Minimum two (2+) years of Revenue Cycle Experience in lieu of degree

Required License/Certifications:

  • 1 or more Certifications
    preferred:


CRCE
  • Certified Revenue Cycle Executive


 CRCP
  • Certified Revenue Cycle Professional


 CRCS
  • Certified Revenue Cycle Specialist


 CHAM
  • Certified Healthcare Access Manager


 CHAA
  • Certified Healthcare Access Associate


 CHFP
  • Certified Healthcare Financial Professional


 CRCR
  • Certified Revenue Cycle Representative

Working Conditions, Equipment, Physical Demands:

There is a