Authorization Coordinator

Stanford Children's Health; Menlo Park (CA); On-site; USD 47,000 - 59,000; Full time

Job summary

Stanford Medicine Children's Health is seeking an Authorization Coordinator who will ensure financial clearance for scheduled services and serve as a resource on complex referral/authorization issues. You will provide high-quality customer service in line with PCARES practices and department regulations.

The role emphasizes collaboration with providers, tracking authorization statuses, and resolving payer issues to minimize financial risk while maintaining patient-focused care.

Qualifications

• Education: High school diploma or GED equivalent.
• Experience: Two years of directly-related experience.
• Licensure/Certification: None required.

Responsibilities

• Act as patient and family advocate between providers and payers' referral/authorization requirements.
• Collaborates with providers and staff to promote referrals and authorizations.
• Tracks and notes patient accounts on authorization status and payer issues; prioritizes urgent cases.
• Processes and follows up on denials, peer-to-peer or medical justification requirements.
• Follows up on authorizations requiring further research or resubmission.
• Ensures authorization claims edits are cleared timely per standards.
• Investigates, resolves and documents insurance issues with stakeholders as needed.
• Coordinates with contracting for letters of agreements for non-LPCH contracted coverage.
• Alerts management to possible deferrals/denials before service date.
• Communicates with access nurse or clinician for necessary triage.

Skills

Effective communication

Analytical thinking

Problem solving

Teamwork

Education

High school diploma or GED

Job description

Company Description

At Lucile Packard Children's Hospital Stanford, we know world-renowned care begins with world-class caring. That's why we combine advanced technologies and breakthrough discoveries with family-centered care. It's why we provide our caregivers with continuing education and state-of-the-art facilities, like the newly remodeled Lucile Packard Children's Hospital Stanford. And it's why we need caring, committed people on our team - like you. Join us on our mission to heal humanity, one child and family at a time.

Job ID: LP_00027209-2661381

Job Description

JOB SUMMARY

This paragraph summarizes the general nature, level and purpose of the job.

Reporting to the Authorization Assistant Manager and/or Supervisor, the Authorization Coordinator is responsible for providing day-to-day financial clearance of scheduled services assigned to the Authorization department work ques), and serving as a resource for all departments on complex referral / authorization issues for problem resolution. The Authorization Coordinator advises on authorization related questions and is expected to serve as a role model throughout the organization as providing high-quality customer service in accordance with established Hospital PCARES practices and department specific regulations, policies and procedures.

ESSENTIAL FUNCTIONS

The essential functions listed are typical examples of work performed by positions in this job classification. They are not designed to contain or be interpreted as a comprehensive inventory of all duties, tasks, and responsibilities. Employees may also perform other duties as assigned.

Employees must abide by all Joint Commission Requirements including but not limited to sensitivity to cultural diversity, patient care, patient rights and ethical treatment, safety and security of physical environments, emergency management, teamwork, respect for others, participation in ongoing education and training, communication and adherence to safety and quality programs, sustaining compliance with National Patient Safety Goals, and licensure and health screenings.

Must perform all duties and responsibilities in accordance with the hospital's policies and procedures, including its Service Standards and its Code of Conduct.

• Act as a patient and family advocate between obtaining necessary information from providers and fulfilling payers' referral/authorization requirements.
• Collaborates with corresponding providers and staff members from service sites to promote the success of obtaining referrals and authorizations.
• Tracks and notes patient accounts on the authorization status, follow up and payer issues. Assists respective Authorization team members in prioritizing clinically urgent cases and secure authorizations in advance to minimize LPCH's potential financial risks.
• Processes and follows-up on authorizations that have denials, peer-to-peer or further medical justification requirements.
• Follows-up on and corrects authorizations that require further research, review, or resubmission.
• Ensures all authorization claims edits holding claims are cleared timely and effectively in accordance to department and organizational set metrics and authorization standards.
• Investigate, resolve and document insurance issues in a timely and efficient manner, and contact corresponding stakeholders (Authorization Management, medical staff, other clinical staff, ancillary departments and administration) as needed.
• Facilitates the coordination with contracting to obtain letters of agreements for patients and families who have non-LPCH contracted coverage.
• Informs corresponding Authorization Assistant Manager of any possible deferrals / denials of elective / non-emergent service requests that have not been approved prior to service date.
• Communicate with access nurse and/or appropriate clinician for necessary triage and/or to help resolve any insurance issues.

Qualifications

MINIMUM QUALIFICATIONS

Any combination of education and experience that would likely provide the required knowledge, skills and abilities as well as possession of any required licenses or certifications is qualifying.

Education: High school diploma or GED equivalent

Experience: Two years of directly-related experience

Licensure/Certification: None required.

KNOWLEDGE

• Ability to analyze operational and procedural problems and develop, recommend and evaluate proposed solutions.
• Ability to speak and write effectively at a level appropriate for the job.
• Ability to work well with individuals at all levels of the organization.
• Knowledge of computer systems and software used in functional area.
• Knowledge of Medical Terminology.
• Knowledge of Medicare, Medi-Cal, Workers Comp, Managed Care (HMO, PPO, POS, etc ), Children's Health Programs (CCS, GHPP, Healthy Families, etc ).

PHYSICAL REQUIREMENTS

The Physical Requirements and Working Conditions in which the job is typically performed are available from the Occupational Health Department. Reasonable accommodations will be made to enable individuals with disabilities to perform the essential functions of the job.

Additional Information

Pay Range

Compensation is based on the level and requirements of the role.

Salary within our ranges may also be determined by your education, experience, knowledge, skills, location, and abilities, as required by the role, as well as internal equity and alignment with market data.

Typically, new team members join at the minimum to mid salary range.

Minimum to Midpoint Range (Hourly): $34.06 to $42.57

Stanford Medicine Children's Health (SMCH) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SMCH does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements, and where applicable, in compliance with the San Francisco Fair Chance Ordinance.