Authorization Coordinator

Overview

Catholic Health is one of Long Island's finest health and human services agencies. Our health system has over 16,000 employees, six acute care hospitals, three nursing homes, a home health service, hospice and a network of physician practices across the island.

At Catholic Health, our primary focus is the way we treat and serve our communities. We work collaboratively to provide compassionate care and utilize evidence based practice to improve outcomes - to every patient, every time.

We are committed to caring for Long Island. Be a part of our team of healthcare heroes and discover why Catholic Health was named Long Island's Top Workplace!

Job Details

The Financial Clearance Authorization Coordinator is responsible for ensuring a patient's visit is financially secured, which requires communication with patients, physicians, office staff, clinicians, and insurance companies to obtain and accurately record patient demographic and insurance information.

The role performs insurance verification, insurance notification and authorization, patient financial responsibility communication, and other patient access operational activities for the Catholic Health. The Authorization Specialist role is responsible to submit prior authorizations timely, and that required clinical criteria is complete and accurate according to payer requirements.

The role will work closely with Utilization Management, Patient Accounts, and other key stakeholders in the revenue cycle to ensure all pertinent patient and insurance information is on file for clinical submission and billing.

DUTIES / RESPONSIBILITIES :

• Determine whether authorization is required and utilize payer-specific requirements to secure authorization.
• Submit prior authorization requests to payers on behalf of the hospital or physician.
• Ensure the required prior authorization clinical documents are complete and timely to ensure submissions are complete.
• Setup and support Peer-to-Peer reviews between medical directors and physicians.
• Coordinate with clinical staff to provide proof of medical necessity.
• Utilize WQs and reports, as assigned by management, to ensure completion of financial clearance functions for all in-scope patients.
• Confirm and document the patient's health insurance(s) effective dates, network status, service coverage requirements, and patient liabilities including deductible, coinsurance and co-payment amounts. This may be completed multiple times before, during, and after a patient's visit / stay.
• Use financial estimate process to make patients aware of estimated financial responsibility, collect and document receipt of estimated patient responsibility amounts prior to service, and appropriately refer them to financial counseling when necessary.
• Utilize problem solving skills to determine the best course of action to resolve any problems created as a result of insurance coverage or prior authorizations.
• Foresee and communicate to management team any significant issues / risks.
• Propose innovative ideas and solutions to enhance operational efficiencies.
• Maintain knowledge of The Joint Commission and state / federal regulations, laws and guidelines that impact Financial Clearance functions and Patient Access Services.
• Comply with Medical Necessity protocols and proper use of Compliance Checker and National and Local Coverage Decisions.
• Maintain knowledge of Medicare, Medicaid and third-party payer regulations and hospital charging and collection policies.
• Responsible for other duties as assigned.

POSITION REQUIREMENTS AND QUALIFICATIONS :

Education :

High School Diploma or equivalent experience required

Skills :

Core CHS Behaviors : The following behaviors have been identified as critical to all leadership roles at CHS.

Role-Specific Behaviors : these additional behaviors are necessary in the role :

Skills, Knowledge or Abilities critical to this role :

Experience :

Minimum experience of 2 years in Revenue Cycle Management or Patient Access Services functions. Insurance Verification and Insurance Pre-Certification / Authorization experience preferred.

Posted Salary Range

USD $21.00 - USD $27.00 / Hr.

This range serves as a good faith estimate and actual pay will encompass a number of factors, including a candidate's qualifications, skills, competencies and experience. The salary range or rate listed does not include any bonuses / incentive, or other forms of compensation that may be applicable to this job and it does not include the value of benefits.

At Catholic Health, we believe in a people-first approach. In addition to the estimated base pay provided, Catholic Health offers generous benefits packages, generous tuition assistance, a defined benefit pension plan, and a culture that supports professional and educational growth.