Job Description: As an insurance verification and authorization access coordinator, you will be responsible for independently managing all work related to medical necessity-based authorizations for all scheduled surgeries, Outpatients, and inpatients, as well as elective and direct medical admissions. Able to determine a patient's eligibility and identify specific insurance benefits for all Scheduled Surgeries, Outpatient and Inpatient, and Elective, Emergent, and Direct medical admissions. Possess a strong knowledge of Insurance payors while demonstrating a solid understanding of payer coverage policies and applying appropriate payer criteria and guidelines.

The coordinator will leverage their medical terminology and physiology understanding to retrieve the appropriate clinical documents (e.g., progress notes, lab values, scan results) from the electronic medical record (EMR). The Access Coordinator will complete specific forms and enter required information via payor portals to secure prior authorization, reduce penalties, and achieve maximum reimbursement.

Responsibilities:

• Reviews and monitors all insurance verification work queues, identify, and prioritizes accounts with the greatest financial reimbursement risk.

• Reprioritizes work to respond to urgent clinical needs and produces high quality work under pressure.

• Verifies insurance eligibility and benefits, utilizing automated eligibility systems, payer portals, or telephone communication.

• Prepares and completes payer-specific prior authorization requests, interprets medical policy criteria, and applies appropriate guidelines to prior authorization requests.

• Identifies appropriate medical documentation to satisfy payer medical policy criteria.

• Respond to health plan-reviewed prior authorization requests that do not meet initial policy criteria. Works with the health plan to resolve issues and/or coordinates appropriate provider-to-health plan interventions (e.g., peer-to-peer discussions, letters of medical necessity, provider-initiated appeals, etc.).

• Provides superior customer service to all patients, works through patient-raised issues, and recommends appropriate solutions.

• Interfaces with provider’s offices and medical staff to ensure all necessary documentation is obtained for purposes of pursuing a successful authorization approval.

• Documents accurately into the Electronic Medical Record (EMR) system all actions, interactions, and authorizations surrounding the insurance process for each patient.

• This position has no supervisory responsibilities.

• Duties, responsibilities, and activities may change at any time with or without notice.

• Other duties may be assigned as needed by leadership team.

Qualifications:

• Minimum Required: 1 - 2 Years equivalent experience completing Registration, Scheduling, Pre-certifications/prior authorizations in a hospital setting, medical office setting, Patient Access, or similar environment. High School Diploma/GED
• Preferred: 3 - 5 Years equivalent experience completing Registration, Scheduling, Pre-certifications/prior authorizations in a hospital setting, medical office setting, Patient Access, or similar environment.
• Desire an independent, detail-oriented worker with strong analytical skills to meet productivity and quality measures.