Authorization Coordinator

Stanfordmedicinechildrenshealth; United States; On-site; USD 60,000 - 85,000; Full time

Job summary

Lucile Packard Children’s Hospital Stanford is seeking an Authorization Coordinator to manage day-to-day financial clearance for scheduled services and serve as a resource on referral and authorization issues across departments.

Reporting to the Authorization Assistant Manager, the role emphasizes high-quality customer service, adherence to PCARES practices, and regulatory compliance in all activities.

Qualifications

• Requires effective communication and problem-solving abilities.
• Strong customer service and patient advocacy skills.
• Ability to analyze operational and procedural problems and propose solutions.
• Knowledge of medical terminology and payer processes.

Responsibilities

• Act as a patient and family advocate to obtain necessary information for referrals and authorizations.
• Collaborate with providers and staff to obtain referrals and authorizations.
• Track, follow up, and resolve authorization issues and denials.
• Ensure authorizations are completed timely to minimize financial risk for the organization.
• Coordinate with departments and payers to resolve insurance issues and deferrals.

Education

High school diploma or GED

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.

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.

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 ro