[Hiring] Coordinator - Prior Authorization Verification and Eligibility @Luminis Health

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 continued 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; perform 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 place 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 all benefits (Copays, Deductibles, Co-Insurance, OOP, LTM), authorizations, pre-certifications, and financial obligations of patients clearly and accurately.
• Maintain a close 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 all related PAVE account issues within defined time frames.
• Contact payer to obtain prior authorization and gather additional clinical and coding information as necessary.
• Provide standardized documentation within the system to identify prior authorization and verify that all insurance requirements have been met.
• Notify patient, Provider’s Office, Scheduling, and Financial Counselor immediately when insurance coverage is inadequate or has been terminated.
• Advise providers and their clinical staff when issues arise relating to obtaining prior authorization; educate 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.
• Perform 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 Microsoft Office and Outlook.
• Excellent verbal and written communication skills.
• Preferred experience with the Epic Hospital Billing System.
• Associates Degree in Accounting, Finance, Business Administration, or Healthcare related field preferred.
• Minimum two (2+) years of Revenue Cycle Experience in lieu of degree.

Requirements

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

Benefits

• Medical, Dental, and Vision 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