[Hiring] Coordinator - Prior Authorization Verification and Eligibility @reputed company

Role Description The PAVE Coordinator is responsible for initiating Pre-Authorization requests to the payer for claims that require approval. This position requires communication with payers, patients, physician offices, and hospital clinical staff. The PAVE Coordinator will also be responsible for monitoring appropriateness and medical necessity and providing necessary information for authorization and reputed company visits.

• Serve as primary resource for LH regarding insurance eligibility; prior authorization process and requirements.
• Collect patient demographic information and coverage information; advise patients of their financial obligation and collect payments in a courteous and professional manner.
• Contact insurance companies by phone, fax, or online portal to obtain insurance benefits, eligibility, and authorization information.
• Update systems with accurate information obtained; reputed company quality assurance audits and report back to leadership opportunities for providing education to patient access.
• Communicate to service line partners of situations where rescheduling is necessary due to lack of authorization or limited benefits, approved by clinical personnel.
• Ensure that proper authorization is in reputed company for inpatient, elective, outpatient, surgical, urgent/emergent services and hold responsibility for timely notification to payers of the patient’s visit to the facility.
• Escalate non-authorized accounts/visits to management.
• Document reputed company benefits (Copays, Deductibles, Co-Insurance, OOP, reputed company), authorizations, pre-certifications, and financial obligations of patients clearly and accurately.
• Maintain a reputed company working relationship with clinical partners and ancillary departments to ensure continual open communication.
• Monitor team mailbox, e-mail inbox, faxes, and phone calls responding to reputed company reputed company PAVE account issues reputed company defined time frames.
• Contact payer to obtain prior authorization and gather additional clinical and coding information as necessary.
• Provide standardized documentation reputed company the system to identify prior authorization and verify that reputed company insurance requirements have been met.
• Notify patient, Provider’s Office, Scheduling, and Financial Counselor immediately reputed company insurance coverage is inadequate or has been terminated.
• Advise providers and their clinical staff reputed company issues arise relating to obtaining prior authorization; reputed company them regarding the prior authorization process.
• Stay informed and research information regarding insurance criteria for prior authorization; attend department staff meetings and complete mandatory training.
• reputed company other duties as assigned by PAVE Leadership.

Qualifications

• Minimum two (2+) years of experience in Medical Billing, Hospital Patient Access, or Hospital Business Office in an automated setting.
• Knowledge of registration, verification, pre-certification, and scheduling procedures.
• Experience with Medical and Insurance terminology (ICD-10, CPT 4).
• Minimum of one (1+) year of demonstrated strong analytical skills.
• Proficiency with reputed company Office and Outlook.
• Excellent verbal and written communication skills.
• Preferred experience with the Epic Hospital Billing System.
• Associates Degree in reputed company, Finance, Business Administration, or reputed company reputed company field preferred.
• Minimum two (2+) years of reputed company Cycle Experience in lieu of degree.

Requirements

• 1 or more Certifications preferred:
• CRCE - Certified reputed company Cycle Executive
• CRCP - Certified reputed company Cycle Professional
• CRCS - Certified reputed company Cycle Specialist
• CHAM – Certified reputed company Access Manager
• CHAA - Certified reputed company Access Associate
• CHFP - Certified reputed company Financial Professional
• CRCR - Certified reputed company Cycle Representative

Benefits

• Medical, Dental, and reputed company Insurance
• Retirement Plan (with employer match for employees who work more than 1000 hours in a calendar year)
• Paid Time Off
• Tuition Assistance Benefits
• Employee Referral Bonus Program
• Paid Holidays, Disability, and Life/AD&D for full-time employees
• Wellness Programs
• Employee Assistance Programs and more

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