Authorization Coordinator

Are you passionate about the patient experience? At HCA Healthcare, we are committed to caring for patients with purpose and integrity. We care like family! Jump-start your career as a(an) Authorization Coordinator today with TriStar Joint Replacement Institute.


Job Summary and Qualifications

Full time (Monday - Friday, day shift), no nights, no on-call, no weekends, no holidays

The Authorization Coordinator is responsible for timely and accurate processes associated with some or all of the following job duties; pre-certification, obtaining and certifying authorizations, assisting with appeals of authorizations. Additionally, collaborates with the referral coordinator to ensure that all approvals are obtained.

What you will do in this role:

Responsible for review and completion of prior authorizations to ensure timeliness of appointments, testing, procedures, and claims filing.

Obtain clinical information (including but not limited to medical history, diagnosis, and any relevant lab reports) necessary to complete the Prior Authorization to include insurance requirements.

Follow the criteria for all services requiring prior authorizations and submit requests in a timely manner. Ensure appropriate documentation is entered into the standard billing system. Ensuring that this documentation entry is performed in all needed systems.

Tracks status of prior authorizations via payor authorization portals

Reviews denied claims for clinical accuracy, corrects errors for claims resubmission.

Clearly support patient experience through patient-centered communications demonstrating excellent customer service skills

Communicate with insurance companies to pre-certify/authorize/amend services

Recommend new approaches, policies, and procedures to influence continuous improvements in department's efficiency and services performed

Actively participate in problem identification and coordinates resolution between appropriate parties

Utilize appropriate communication system to facilitate communication with hospital partners

Ensure appropriate documentation is entered in standard format in billing system. This should be performed in the applicable Health Information System (i.e. Source systems) and if necessary, any other subsidiary systems if they are not automatically updated. - Is this redundant from bullet three? Could probably combine this one and bullet three into one statement.

Research Patient Visit History to ensure compliance with payor specific payment window rules; appropriately communicate patient payment responsibilities and guide them through needed steps.

Performs other related job functions as assigned

Practice and adhere to the Code of Conduct and Mission, and Value Statements.

What Qualifications you will need:

EDUCATION:

High School Diploma or GED equivalent required

EXPERIENCE:

One year of related experience with medical insurance plans and/or Medicare benefits verification required.

One-year medical clinic, urgent care, or hospital care setting experience preferred

Prior Authorization experience preferred

CERTIFICATION/LICENSE:

None require

Benefits

TriStar Joint Replacement Institute, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services
• Wellbeing support, including free counseling and referral services
• Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence
• Savings and retirement resources , including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling
• Education support through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing
• Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts

Learn more about Employee Benefits


Note: Eligibility for benefits may vary by location.

Supporting HCA Healthcare's 186 hospitals and 2,400+ sites of care, Physician Services plays a crucial role as the main entry point for patients looking for high-quality healthcare within the HCA Healthcare system. With a focus on meeting the needs of our patients at all access points, Physician Services is dedicated to implementing innovative, physician-driven, value-added solutions to assist physicians in providing high-quality, patient-centered care, aligning with our mission to care for and enhance human life.

HCA Healthcare has been recognized as one of the World's Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in costs for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

"The great hospitals will always put the patient and the patient's family first, and the really great institutions will provide care with warmth, compassion, and dignity for the individual."- Dr. Thomas Frist, Sr.
HCA Healthcare Co-Founder
If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply for our Authorization Coordinator opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews. Unlock the possibilities and apply today!

We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.