Access Coordinator

Essentia Health; Duluth (MN); Hybrid; USD 42,000 - 54,000; Full time

Job summary

Essentia Health is looking for an Access Coordinator who translates patient information into the system to ensure accurate claim submissions. The role requires coordinating insurance verification, authorizations, and medical documentation with clinicians and patients, while ensuring timely processing in the EMR.

The position emphasizes accuracy in insurance processes, collaboration with care teams, and proactive handling of authorizations and pre-service activities to support reimbursement and

Qualifications

• 1 year of relatable healthcare experience.

Responsibilities

• Prepares and submits payer-specific prior authorizations and referrals in alignment with guidelines and medical policy.
• Identifies required insurance verification and medical documentation per payer policy.
• Collaborates with clinicians to obtain necessary information for authorization approval.
• Documents all interactions and actions related to insurance processes in the EMR system.
• Monitors work queues, focusing on accounts with high reimbursement risk.
• Adapts to urgent clinical needs while maintaining quality within timelines.
• Communicates with patients to facilitate medical clearance.
• Develops pre-service estimates and supports pre-service collections.
• Reviews prior authorization requests that do not meet criteria and coordinates interventions with stakeholders.

Job description

Job Description:

The Access Coordinator gathers necessary insurance information and uses expertise to translate the information provided by the patient/guarantor into the computer system, resulting in accurate claim submissions.

Education Qualifications:

Key Responsibilities:

• Prepares and submits payer-specific prior authorizations and referrals in alignment with relevant guidelines and medical policy criteria


• Accurately identifies required insurance verification and medical documentation in accordance with payer policy


• Collaborates with clinicians and medical practitioners to obtain all necessary information for successful authorization approval


• Thoroughly documents all interactions and actions related to insurance processes within the electronic Medical Record (EMR) system


• Regularly reviews and monitors assigned work queues, identifying, and focusing on accounts with the highest financial reimbursement risk


• Adapts to urgent clinical needs while maintaining high-quality work outputs within specified timelines


• Communicates with patients as needed to facilitate medical clearance


• Develops pre-service estimates and supports pre-service collections


• Supports the review of prior authorization requests that do not initially meet criteria and works collaboratively with relevant stakeholders to resolve issues or coordinate necessary clinician-to-health plan interventions

Required Qualifications:

• 1 year of relatable healthcare experience

Preferred Qualifications:

• Healthcare experience within patient care, registration, scheduling, pre-certifications/prior authorizations, collections, and medical terminology