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.

• Collaboration & Teamwork: works cooperatively & collaboratively with others toward the accomplishment of shared goals.

• Valuing Diversity: recognizing and embracing the unique talents and contributions of others.

• Service Orientation: desire to serve and focus one’s efforts on discovering and meeting the needs of internal and external customers.

• Achieves Results: reflects a drive to achieve and outperform. Continuously looking for improvements. Accepts responsibility for actions and results.

• Organizational Alignment: ability to align people, processes and organizational structure with CHS’s strategic direction.

• Developing Others: views people, their knowledge and capabilities as assets and provides opportunities that allow employees to continuously learn and develop.

• Communication: practices attentive and active listening and can restate opinions of others; communicates messages in a way that has the desired effect.

• Integrity: conducts business with honesty and professional ethics. Seeks to achieve results in the best interest of the organization. Models and reinforces ethical behavior in self and others.

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

• Relationship-building – able to develop and maintain relationships with a variety of types of positions and individuals at both the hospital and system level.

• Motivation – able to motivate and mentor staff to perform at high levels of expertise and productivity.

• Problem Solving – Analyzes interrelated elements of problems and works systematically to solve them, uses sound judgment to develop efficient and feasible resolutions to challenging issues.

Skills, Knowledge or Abilities critical to this role:

• Must have a comprehensive understanding of insurance pre-certification requirements, contract benefits, and medical terminology.

• Work requires the ability to access online insurance eligibility and pre- certification systems.

• Must have expertise in insurance, managed care and federal/ state coverage.

• Must be customer focused with strong interpersonal skills and courteous with patients, family members, physicians, and staff members.

• Must be able to discuss and complete financial arrangements on the estimated patient liability under stressful conditions while maintaining positive patient relations.

• Work requires a high level of problem solving skills

• Work requires the ability to interpret and execute policies and procedures.

• Work requires the ability to ensure the confidentiality and rights of patients and the confidentiality of hospital and departmental documents.

• Must be able to demonstrate a working knowledge of personal computers and other standard office equipment

• Must demonstrate a positive demeanor, good verbal and written communication skills, and be professional in appearance and approach.

• Must be able to handle potentially stressful situations and multiple tasks simultaneously.

• Must be able to successfully complete additional job related training when offered.

Experience:

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

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.