Authorization Coordinator

10 Driscoll Children's Hospital; United States; On-site; USD 42,000 - 60,000; Full time

Job summary

Driscoll Children’s Hospital in Texas is seeking a Scheduling Coordinator to work with nursing staff and families to schedule surgeries. You will verify insurance coverage and coordinate authorizations needed for all surgeries for in-patient and out-patient care.

Using the EPIC EMR system, you will coordinate surgical clearances and act as the primary liaison between the OR, physicians, and families to ensure fair and efficient scheduling of procedures.

Qualifications

• High school diploma or GED and 2–3 years related experience and/or training in medical field; or equivalent combination of education and experience.

Responsibilities

• Maintains confidentiality at all times.
• Calls insurance companies for pre-certifications requirements.
• Obtains prior authorizations for hospital services and medications.
• Ensures surgical clearances are obtained prior to scheduled surgeries.
• Coordinates surgeries with physicians and OR staff to optimize scheduling.

Skills

Communication skills

EPIC EMR

Pre-certifications

Education

High school diploma or GED

Tools

EPIC EMR system

Job description

General Purpose of Job:

Using the EPIC EMR system, individual will be responsible for working with nursing staff and patients’ family to schedule surgeries. Verifies insurance hospital coverage for all patients and facilitate the authorizations needed for all surgeries for both inpatient and outpatient benefits. Individual also will have to ensure all surgical clearances needed prior to surgery including cardiac, neurological and pulmonology are obtained. Will act as primary liaison between Driscoll Children’s Hospital’s operating room, physicians and/or their designees regarding the scheduling of all surgical procedures. Ensures fair and even administration of the rules regarding the scheduling of elective surgical procedures. Also works as liaison between family and hospital financial coordinator when families do not have insurance for patients who urgently need surgery.

Essential Duties and Responsibilities:

• Maintains utmost level of confidentiality at all times.
• Adheres to hospital policies and procedures.
• Calls insurance companies for pre-certifications requirements.
• Calls Pharmacy for prior authorization for medications, specialty drugs and biologic meds.
• Obtains prior authorizations for both in-patient and outpatient services for all patient cases.
• Ensures that patients that require surgical clearances are obtain prior to the scheduled surgery.
• Ensure that all medications that need prior authorization are done and ready for the patients surgery Coordinates and works with DME companies for any devices which require authorization.
• Ensure that home health is coordinated prior to patient discharge as necessary.
• Coordinates schedules with outside vendors that support the physicians including Plastics & Dermatology for any surgeries that require such services.
• Coordinates surgeries with other surgeons including Plastic Surgery, ENT, Urology, Orthopedics & Neurosurgery for patients that require multiple services.
• Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.
• Inputs appropriate data necessary for proper and accurate scheduling of elective surgical procedures.
• Ensures thorough schedule management that optimizes utilization of elective surgical time and surgical equipment.
• Maintains and updates the EPIC surgical scheduling system .
• Troubleshoots problems with scheduling system and identifies / implements corrective actions.
• Obtains consent signatures of parents/guardians for hospital surgical consents.
• Communicates with OR Manager, OR Scheduler, Nurse Coordinator, and Clinic Director for problem resolution or to provide information of pending issues.
• Provides admitting physicians and/or consultants with appropriate patient information and insurance benefits Adheres to current scheduling policies & procedures and ensures even and fair application of policies and procedures for all physicians utilizing DCH’s operating room.
• Uses appropriate communication and interpersonal skills to facilitate problem resolution.
• Assist families coordinate their over nights stays with lodging at the Ronald McDonald House, hotel reservations, transportation and immigrations letters to travel for their child’s surgery.
• Cancel and/or Reschedule surgeries as necessary.
• Performs other duties as needed and assigned.

Education and/or Experience:

High school diploma or general education degree (GED); and two to three years related experience and/or training in medical field; or equivalent combination of education and experience.

Until all children are well.

Driscoll Children’s Hospital and its specialty centers, urgent care centers, and after-hours facility serve a vast area covering 31 South Texas counties. The hospital is a 191-bed tertiary care center offering 32 medical and 13 surgical specialties. Combined with our non-profit, community-based Health Plan, Driscoll Health System is an exceptional workplace for anyone with a big heart and a drive for success. Smiles, hugs and a soothing touch are as much a part of Driscoll’s approach to treating children as is its advanced medical treatments and technologies. The core values at Driscoll Heath System are: Compassion, Advocacy, Respect, Excellence, and Stewardship. These values are exemplified through every position - from treating the most critical patients hands-on, to maintaining a clean environment, to keeping the organization running from behind the scenes. We invite you to learn about Driscoll’s rich history and explore the laidback lifestyle South Texas has to offer.