Central Authorization Coordinator - Communities

It's fun to work in a company where people truly BELIEVE in what they're doing!

Our intention is to have employees who are passionate about making their personal mission statement come to life each day at work! Be it through providing healing, eradicating loneliness, contributing to efficiencies, streamlining processes, being dependable, sparking creativity or something else, the demonstration of HOW you do your job is just as important as WHAT you do in your job.

Alongside our valued employees, we are making a difference throughout the state of Ohio in the lives of those that need healthcare or those embracing the next chapter of their lives. Sustained members of our team demonstrate accountable behavior and share our values of customer service, innovation, inclusion, integrity, financial stewardship, leadership and care.

The Central Authorization Coordinator coordinates and processes all new and extended cases within the workflow of the Central Authorization Department through verification of insurances, setting up patient demographic and billing information, and submitting all insurance authorizations required by the payer with accuracy and knowledge of third party payers in accordance with company standards and federal, state, and local standards, guidelines, and regulations.

Essential Activities and Tasks  

Authorization Verification and Management - 60%

• Receives all Medicare Part B referrals from the life plan communities via the Central Authorization email account.

• Verifies and accurately interprets patient benefits via online portals and communicates information back to the referring life plan community within one hour via the Outpatient Patient Benefit Disclosure for all therapy services.

• Follows up on all submitted authorizations to ensure that all authorizations are approved in an acceptable time frame.

• Submits all re-authorization requests for additional services through the Central Authorization email. Tracks and follows up on all re-authorizations in same manner as initial pre-certification request.

• Tracks all referrals and authorization times via the Central Authorization Tracking Log and must be kept up-to-date no later than the next business day.

• Communicates any issues, location or payer-related, to the Third Party Accounts Receivable Manager as they arise.

• Sends electronic copies of all insurance verifications to the locations with initial insurance verification.

• Communicates patient responsibility and authorization requirements via the Outpatient Patient Benefit Disclosure.

• Submits all authorizations for services once evaluation is received by referring life plan community electronically or by fax.

Appeal Tracking and Administration - 20%

• Sends medical record appeal packets sent by therapy vendors, Director of Nursing, Regional Directors of Clinical Operations (RDCO) and administrative staff.

• Enters all tracking information and appeal updates on the Additional Development Request (ADR) log.

• Systematically reviews Retrospective Post Payment Medical Record Reviews for takeback adjustments and clears entries over 90 days old that have not been adjusted or resubmitted by entering payment amount on ADR log.

• Communicates with Third Party Accounts Receivable Coordinators and RDCOs on all appeal correspondences and updates.

Data Entry - 20%

• Creates facesheet, as needed, and verifies that all demographic and billing information is accurate and complete through validation of patient-supplied information from the referring facility.

• Completes all Authorization related workflow tasks, as needed, for data integrity.

• Ensures statement set-up is complete prior to month-end close.

• Enters all authorization numbers for all services in billing systems in a timely and accurate manner.

• Tracks all outpatient start and end of care episodes in the electronic medical records system.

• May be responsible for therapy billing code entry.

All other duties as assigned.

Qualifications

Education

• High school diploma or equivalent required.

Experience

• Experience in insurance, billing, or central intake roles or other insurance authorization required.

• Experience in long-term care, hospital, or other related healthcare accounting preferred.

• Experience with Medicare Advantage and Medicaid eligibility preferred.

• Proficiency with Windows, Microsoft Office (Word, Excel, PowerPoint), and the internet required.

Other Requirements

• Must be able to read, write, speak, and understand the English language.

Working Conditions and Special Requirements

• Sitting - Up to 8 hours/day

• Standing - Up to 2 hours/day

• Walking - Up to 2 hours/day

• Lifting, transferring, pushing or pulling equipment/supplies - Up to 25 pounds

• Driving - Up to 6 hours/day

• Work weekends, evenings, and holidays - As needed for coverage

• Risk Category for Exposure to Bloodborne Diseases - III