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Patient Authorization Coordinator
2 months ago
The Patient Authorization Coordinator plays a crucial role in ensuring the verification of patient benefits and eligibility. This position involves securing all necessary pre-authorizations and pre-certifications for scheduled medical procedures.
This specialist collaborates closely with insurance carriers and internal staff to review, investigate, and resolve authorization appeals, address rejected claims, and inform patients, scheduling personnel, and the billing department regarding any services that lack insurance authorization.
The role also includes determining patient financial responsibility for the services rendered and communicating this information effectively to the patient.
Key Responsibilities:
- Secure pre-authorization for all medical procedures and treatments prior to patient appointments.
- Ensure patient insurance details are accurate and properly documented.
- Investigate and analyze patient CPT codes that may not have been initially recorded during the pre-authorization process.
- Timely review and resolve all authorization-related issues.
- Communicate authorization status, along with any financial and benefit coverage details, to patients and providers in a professional manner.
- Gather necessary documentation to support the approval or denial of authorizations.
- Maintain the confidentiality and security of patient files in accordance with HIPAA regulations.
- Report trends identified with payers to management to help minimize future issues.
- Participate in special projects as assigned.
Qualifications:
- High school diploma or equivalent
- Experience in a healthcare environment is required
- Knowledge of ICD-10 and CPT coding is essential
- Proficiency in Microsoft Office Suite
- Comprehensive understanding of authorization processes is necessary
Gastro Care Partners is dedicated to empowering regional gastroenterology practices with the essential resources to thrive in the evolving healthcare landscape while preserving their unique identities.
We uphold the belief that "medicine is local."
