Insurance Authorization Coordinator

3 hours ago

Denver, Colorado, United States Orthopedic Centers of Colorado Full time
Job Overview

POSITION SUMMARY:

The Insurance Authorization Coordinator plays a vital role within the authorization department, working closely under the guidance of the practice manager. This position is essential for securing necessary authorizations for physical and occupational therapy services, along with other ancillary procedures as required. The specialist will engage regularly with both medical personnel and patients to facilitate these processes.

KEY RESPONSIBILITIES:

  • Efficiently manage the Therapy EMR and navigate various payer authorization platforms to secure approvals for scheduled treatments, including initial assessments, follow-up visits, durable medical equipment (DME), and other services requiring authorization. Confirm eligibility and benefits for all relevant procedure codes.
  • Examine patients' medical histories and insurance plans to determine approval eligibility. Document all procedural workflows as mandated.
  • Communicate with referring physicians to gather additional information as necessary, ensuring all documentation is processed and routed correctly to comply with physician and regulatory standards.
  • Input and update patient information accurately within the system.
  • Record prior authorization details in the Electronic Health Record (EHR), including the number of authorized treatments, duration of authorization, authorization numbers, and contact details for insurance providers.
  • Assist with administrative tasks as required.
  • Recognize and respond appropriately to urgent or emergency situations.
  • Adhere to all established protocols and procedures of the clinic, including the OCC handbook and departmental policies.
  • Exhibit professionalism and courtesy towards patients and their families.
  • Ensure effective communication via telephone when necessary.
  • Collaborate as a team member within the authorization department and across other departments.

QUALIFICATIONS AND SKILLS REQUIRED:

  • Familiarity with medical terminology, ICD-10, and CPT coding.
  • Understanding of contracted insurance plans and their procedures.
  • Proficient computer and telephone skills.
  • Strong organizational and interpersonal abilities.
  • Capability to prioritize tasks and manage multiple responsibilities efficiently.
  • Flexibility to adapt to varying plan and lien requirements.

WORK ENVIRONMENT:

This role is typically situated in a standard business office setting with potential for local travel. The position involves frequent use of a computer monitor, including mousing and typing, along with regular standing, walking, and sitting. Physical demands may include frequent bending, lifting, carrying, and pushing/pulling of items weighing 10 pounds or more, with occasional lifting of up to 50 pounds. Specific vision capabilities required include close vision, color vision, peripheral vision, and the ability to adjust focus. Standard business hours are Monday through Friday, with flexibility needed for early, late, and extended hours as necessary to fulfill job responsibilities.

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