[Hiring] Senior Coordinator - PAVE @Luminis Health

Role Description

The Sr. 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 Sr. 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 and prior authorization process.
• Collect patient demographic and coverage information; advise patients of their financial obligations.
• Contact insurance companies to obtain benefits, eligibility, and authorization information.
• Update systems with accurate information; perform quality assurance audits.
• Communicate with service line partners regarding rescheduling due to lack of authorization.
• Ensure proper authorization for various services and notify payers timely.
• Document all benefits, authorizations, and financial obligations clearly and accurately.
• Maintain a close working relationship with clinical partners and ancillary departments.
• Monitor team mailbox, e-mail inbox, faxes, and phone calls for PAVE account issues.
• Contact payers to obtain prior authorization and gather additional information as necessary.
• Provide standardized documentation within the system for prior authorization.
• Advise providers and their clinical staff on prior authorization issues.
• Stay informed about insurance criteria for prior authorization.
• Attend department meetings and complete mandatory training.
• Perform other duties as assigned by PAVE Leadership.

Qualifications

• Minimum three (3+) years of experience in Medical Billing, Hospital Patient Access, or Hospital Business Office.
• 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.
• Bachelor’s Degree in Accounting, Finance, Business Administration, or Healthcare related field preferred.
• Minimum three (3+) years of Revenue Cycle Experience in lieu of degree.

Requirements

• One (1+) or more certifications from AAHAM, NAHAM, or HFMA required.
• Healthcare Certification.
• 1 or more Certifications required:
• 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