Insurance Authorization Coordinator

The individual in this position works under direction of RN Case Manager and/or Social Worker. The individual’s  responsibilities include but are not limited to the following actions : a) Follow up on patient accounts when authorization for  stay is required , Fax numbers to Send clinical reviews b) Follow up on each account during the stay and on discharge for  authorization - document in the electronic system, c) Escalate any potential disputes or denial of accounts to Director of  Case Management or designee d) Trends disputed claims by at least payor and physician e) assist in obtaining authorization  for patient discharged to Skilled Facilities or other post-acute care that require authorization f) other duties as assigned General Functions Utilization Management   Validates patient’s demographic and payer information with patient/family and notifies Patient Access  immediately if any corrections are needed  Validates that all commercial/managed care discharges have an authorization for status and level of care  provided and notifies Director of Case Management (DCM) or designee of variances   Cases that require authorization are obtained daily by fax or phone and documentation is completed daily  Escalate discharged cases at end of day that have no authorization or notification of dispute is provided by payor  Concurrently make sure all clinical needed by payors and updates are provided by alerting Case Manager  assigned to case and escalating to DCM if not completed timely  Trend dispute/denial potential to DCM or designee by failure points in revenue cycle   Prepare denial information for UR Committee, Denial and Revenue Cycle Meetings  Collaborate with Patient Access, Case Management, Managed Care and Business office to improve concurrent  review process to avoid denial or process delays in billing accounts (85% daily, essential) Transition Management   Follow up on Authorization for post-acute services  Makes referrals for post-acute services under the direction of the RN Case Manager or Social Work (SW) staff  utilizing the Tenet Case Management documentation system  Follow-up if referral requires an authorization by payor to discharge the patient  Completes tasks as assigned by RN or LVN Case Manager and/or SW staff   Makes copies, send faxes and complete phone calls to arrange post-acute services and to ensure that appropriate  hospital information is communicated to post-acute providers   Documents all referrals and tasks in the Tenet Case Management documentation system per Tenet policy  Provides Important Message follow up letter to Medicare beneficiaries per Tenet policy and under the direction of  the RN Case Manager or SW (10%daily, essential)  Compliance   Adheres to federal, state, and local regulations and accreditation requirements impacting case management scope of  services   Adheres to department structure and staffing, policies and procedures to comply with the CMS Conditions of  Participation and Tenet policies (5% daily, essential MINIMUM EDUCATION: High School diploma or equivalent required.

PREFERRED EDUCATION: Associate or Bachelor’s degree MINIMUM EXPERIENCE: Must have excellent organizational skills, excellent verbal and written communication  skills, demonstrated problem solving skills, and computer literacy. PREFERRED EXPERIENCE: Acute hospital experience. Data Analytic skills. REQUIRED CERTIFICATIONS/LICENSURE: N/A PREFERRED CERTIFICATIONS/LICENSURE: Paramedic, EMT or Nursing Assistant REQUIRED COURSES/ COMPLETIONS: N/A PATIENT POPULATION/AGES SERVED: (√) Check all that apply #LI-GF2