Authorizations & Data Coordinator - Rehab - Full-Time - Days - Bayfront Hospital - St Petersburg

Rehabilitation Data Coordinator / Insurance Authorization Specialist

This position is focused on supporting the admissions team by receiving and processing referrals. Will serve as a dedicated Insurance Authorization Specialist responsible for all rehabilitation payer authorizations and appeals. Will also assist in patient admission, improving patient throughput, increasing rehabilitation admissions, reducing avoidable acute care days, and supporting continued program growth.

Responsibilities Essential Functions:

• Completes entry of referrals and/or authorizations into EHR.
• Verifies Insurance information through (Availity, One Source, Passport, United online portal and VA).
• Completes registration in hospital EMR and ensures and financial information and insurance is current and active.
• Communicates with physician advisors and coordinate peer-to-peer discussions for authorizations that have been denied.
• Transcribes faxed referral requests via On-Base fax system into EHR.
• Assigns ICD-10 diagnosis code to authorization requests.
• Submits for insurance authorization, tracks authorization requests and communicates effectively with all internal and external customers- PCP, patient, clinical departments, etc. to obtain the required authorization needed for hospitalization.
• Coordinates with Clinical Liaisons to ensure all necessary insurance information is collected prior to admission.
• Maintains current knowledge of referral and authorization requirements based on payer specific guidelines.
• Maintains working knowledge of ICD-10 codes.
• Demonstrates a basic knowledge of third-party reimbursement requirements and regulations.
• Maintains ability to review medical records and identify information important to admission.
• Maintains positive relationships with Insurance point of contact.
• Exhibits competency in the use of registration systems, electronic verification tools and Web-based resources.
• Understands the importance Orlando Health places on providing exemplary customer service.
• Performs job in a manner that helps meet customer service goals.
• Demonstrates a positive and professional approach and always communicates effectively with customers and team members.
• Maintains flexibility in work schedule availability that allows department to change/modify work schedule to meet departmental needs.
• Investigate insurance denials, resubmit requests and assist appeals when needed.
• Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA and other federal, state and local standards.
• Maintains compliance with all Orlando Health policies and procedures.

Other Related Functions:

• Faxes/copy materials as requested.
• Adheres to corporate and departmental policies regarding confidentiality of patient records, physician information, system data, and other clinical data.
• Maintains records and documentation of work performed in a timely, organized and easily retrievable fashion.
• Maintains confidentiality of data and information in compliance with HIPPA regulation and Orlando Health policies.

Qualifications Education/Training: High school graduate or equivalent. Medical terminology knowledge. Experience: Two (2) years' experience in supporting nursing/clinical leadership. Working knowledge of word processing, spreadsheet, presentation and database software management.