Authorizations Processor

6 days ago

Riverside, United States Arrowhead Orthopaedics Full time

Job Type

Full-time

Description

JOB DESCRIPTION TITLE: Authorization Processor It is our goal to provide the finest Orthopaedic care possible. This philosophy requires that all office staff and Providers be sensitive and responsive to Patients' needs and preferences. To ensure that we hire and retain the quality of staff needed for implementing our philosophy of service, we have adopted the following job description for this position. The position requires that the employee be available forty hours per week and that the employee be flexible in his/her schedule to provide efficient service for the group. The employee however, will be expected to work no more than five days per week. Many of the responsibilities require that you have a working knowledge of computers and the ability to learn the proper use of the programs utilized in this office, or those that which may be necessary to meet the needs of the practice. The hours, pay scale, and benefits will be defined as agreed upon.

BASIC FUNCTION: Under the supervision of the Authorization Supervisor, the Authorization Processor shall provide all responsibilities necessary for the successful operation of the Authorization Department for Arrowhead Orthopaedics.

RESPONSIBILITIES: Work is primarily performed in the Authorization Department located in Arrowhead Orthopaedics' offices. The duties of the Authorization Processor are of high volume, and the quality of duties performed is needed to be at a high level. The employee will come into contact on a daily basis with confidential Patient files. The Authorization Processor must be able to handle this information with the highest degree of privacy, discretion, and professionalism. The Authorization Processor is responsible for accomplishing the duties set forth below:

General Clerical Activities (There may be other duties required of this position not listed below):

  1. Make sure that all actions demonstrate that the PATIENT IS OUR HIGHEST PRIORITY
  2. All phone and Webview messages are to be answered timely throughout the day, and all messages are to be responded to prior to leaving at the end of the day.
  3. The first task of the day is to review personal Dashboard and submit all possible surgery Orders. All Orders are to be submitted within 24 hours. If the Chart Note is not complete and the order cannot be processed, hold the Order in Pending status and check daily. If an Order is not able to be submitted for greater than one week, information Authorization Supervisor of the delay due to pending documentation so that the Authorization Supervisor can communicate with the Provider.
  4. All out-patient and appropriate surgery procedures are sent to AASC for approval/denial and code review.
  5. All Stat Orders are to be submitted immediately and followed up within 24 hours. If Authorization is not received within 12 hours (or sooner if indicated), contact the Supervisor of the referring party for assistance. If Authorization is not obtained within 24 hours (or sooner if needed) communicate with AO Authorization Supervisor for direction and assistance.
  6. Obtain authorization for all HMO, WC, MC and PPO/PVT Surgical Orders requested by designated AO Providers. Surgical Orders include all services noted on the Surgery Order, including but not limited to the surgery, equipment, diagnostic studies/labs, clearance, DME, therapy, medications, and/or home health/SNF services.
  7. Make sure that all information noted on the Surgery Order is accurate prior to moving forward.
  8. All MC and PPO/PVT are to be submitted and forwarded to Surgery Scheduling within 24 hours (unless pending documentation is required).
  9. Inform Patient via Webview that Surgery Authorization has been submitted and instruct Patient to follow up on any lab testing or clearance needs as directed by the Surgery Navigator. Once Authorization has been obtained, inform Patient via Webview or Phone call of appropriate instructions.
  10. WC: If processing a WC Spine Surgery Order, print a copy of the paperwork submitted for authorization as well as the Instructional Letter to the Patient as to how they can submit an IMR should the surgery request be denied. This information is forwarded to the Patient at the time of initial Surgery Order submission.
  11. WC Denial: If requested services are denied, confirm that all appropriate information was sent with the initial request and inform the appropriate Historian for denial processing. Make sure to inform the Historian if any necessary information was missing at the time of initial submission.
  12. All Other Denials: Verify that all appropriate information was sent with initial authorization request. If information was missing, consult with Authorization Supervisor and resubmit order. If all appropriate information had been submitted, inform Authorization Supervisor and then Provider for further direction. Re-process auth accordingly.
  13. Daily check email and Partners messages and resolve as indicated.
  14. Daily check document routing for any incoming authorizations.
  15. Confirm that all outgoing faxes were successful and resend as needed.
  16. Comply with all HIPPA laws and requirements. Maintain a compliant work space and address issues in all areas as they come to your attention (i.e.: Computers not locked down, paperwork visible to Patients, improper communication). HIPPA is EVERYONE'S BUSINESS.
  17. Provide back up coverage to other coordinators in the Authorization Department as directed by Authorization Supervisor.
RELATIONSHIPS: The Authorization Processor should observe and conduct the following relationships:
  1. The employee shall be responsible directly to the Authorization Supervisor. The employee shall report to the Authorization Supervisor and his/her assignees any progress, reports, requests, concerns, problems, and/or expectations in relation to the responsibilities of the position. Such communication may be verbal or written as deemed necessary by the employee or as directed by the Authorization Supervisor or his/her assignee.
  2. The employee shall interact with other office and clinical staff in the Practice. Such interactions should be collegial, professional, and contributing to the safety and pleasantness of the work environment at Arrowhead Orthopaedics.
  3. The employee shall interact with medical groups and Primary Care Physicians and their offices. Such communication should always reflect the total commitment of the office to quality care and customer satisfaction. All communication should be professional and any unresolved conflicts are to be reported to the Authorization Supervisor.
This job description in no way states or implies that these are the only duties to be performed by this employee. The Surgery Authorization Processor will be required to follow any other instructions and to perform any other related duties as assigned by the supervisor and his/her assignees. Arrowhead Orthopaedics reserves the right to update, revise or change this job description and related duties at any time. Furthermore, because it is our goal to provide excellent patient service, I understand that my work will be audited as indicated to ensure that processes and expectations are being maintained both by me and fellow team members who are participating in the patient's care.

Requirements

Skill Requirements:
  1. The ability to type 40 words per minute.
  2. Skill in operating a computer and scanner, as well as software programs including Microsoft Word, Excel, and Outlook.
  3. Telephone etiquette and professional communication skills are required.
Typical Physical Demands:
  1. Requires sitting and walking, with daily occasional stooping, reaching, and bending.
  2. Occasional lifting up to thirty pounds.
  3. Hearing must be in the normal range for telephone and personal communication.
  4. Requires manual dexterity sufficient to operate keyboards and other office equipment.


Salary Description

$17 - $21