The prior authorization coordinator is responsible for following the prior authorization workflow, policies and procedures as established by company.
Essential job functions/responsibilities
Accurately submits requests for prior authorizations to applicable payors within company set standards via payor portals, fax, or phone. Reviews for accuracy and completeness of information submitted to ensure that all supporting documents accompany request as per payor guidelines and requirements. Obtains medical necessity documentation from physician/facility to expedite approvals. Collaborates with interdisciplinary departments to process prior authorizations/appeals according to payor requirements. Manages communication with payors as to ensure timely processing of authorization requests. Documents interactions/communications with payors to ensure timely follow up. Enters prior authorization information including approval dates, visits/units, procedure codes, and prior authorization numbers in patient chart. Reviews and processes insurance/payor denials and submits appeals as applicable by payor. Proactively works on prior authorizations that are due to be expired. Safeguards patients’ demographic and medical information and ensures that all procedures are within hipaa compliance and regulation. Conducts job duties/responsibilities in accordance with the standards outlined in the company’s code of business conduct and ethics, its policies and procedures, the corporate compliance agreement, applicable federal and state laws, and applicable professional standards. Completes all required duties and reports in a timely manner as per daily, weekly, or monthly schedules per company leadership.
The above statements are only meant to be a representative summary of the major duties and responsibilities performed by incumbents of this jobThe incumbents may be requested to perform job related tasks other than those stated in this description.
At least 1 year experience in home healthcare, hospice or other facility where prior authorizations are required. At least 1 year of experience applying knowledge of medicare, medicaid, and managed care prior authorization/reimbursement guidelines. At least 1 year experience in using payor portals Ability to effectively handle multiple tasks within a changing home health environment. Medical terminology knowledge including icd-10 diagnosis and cpt/hcpcs codes for prior authorizations. Experience in identifying, discussing, and resolving prior authorization issues and recommending and implementing strategies to resolve problems. Computer skills including microsoft excel, word, web browsers, etc. Prior axxess home healthcare software emr experience. Prior waystar eligibility/billing system. Computer skills using dropbox web-based document/filing system. Working knowledge of office 365 email.
Skills required * organization
Attention to detail Flexibility Own or have access to desktop/laptop computer
Job types: full-time, part-time, contract
Pay: from $10.00 per hour
Monday to friday
High school or equivalent (required)
Home health prior authorization: 1 year (required) Medicare, medicaid, manage care prior authorization: 1 year (required) Axxess agencycore: 1 year (required) Dropbox: 1 year (required)
Prior Authorization Coordinator
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