Authorization Coordinator Edinburg ENT

15 Driscoll Children's Hospital-Rio Grande Valley; Edinburg (TX); Sur place; USD 32 000 - 45 000; Plein temps

Résumé du poste

Driscoll Children’s Hospital is seeking a Surgical Scheduling Coordinator to manage surgical scheduling using EPIC, verify insurance coverage, and obtain required authorizations for inpatient and outpatient procedures. The role involves coordinating with surgeons, families, and hospital departments to ensure timely, compliant scheduling and approvals.

Ideal candidates will have a high school diploma/GED with medical office experience and familiarity with ICD-10/CPT coding, and strong attention

Qualifications

• Experience in medical administrative operations and scheduling.
• Familiarity with insurance pre-certifications and prior authorizations.
• Understanding of clinical terminology and hospital procedures.

Responsabilités

• Schedule surgeries using the EPIC system and coordinate with surgical staff and families.
• Verify insurance coverage and obtain necessary authorizations for inpatient and outpatient surgeries.
• Ensure surgical clearances (cardiac, neurological, pulmonology) are obtained.
• Coordinate with departments and external vendors to support scheduled procedures.
• Input data for elective surgery scheduling and manage scheduling efficiency.

Connaissances

Scheduling coordination

Authorization management

Insurance pre-certifications

Formation

High school diploma/GED with 2–3 years related medical experience

Outils

ICD-10 coding

CPT coding

Description du poste

General Purpose of Job

Using the EPIC EMR system, individual will be responsible for working with surgical staff and patients family to schedule surgeries. Verifies insurance hospital coverage for all patients and obtains 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’s 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 families hospital financial coordinator when families do not have insurance for patients who urgently need surgery.

ESSENTIAL DUTIES AND RESPONSIBILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as assigned by the immediate supervisor and/or hospital administration as required.

• Maintains utmost level of confidentiality at all times.
• Adheres to hospital policies and procedures.
• Calls insurance companies for pre-certifications requirements.
• Obtains prior authorizations for both in-patient and out-patient 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 wound care vac’s which require authorization.
• Ensure that home health is coordinated prior to patient discharge.
• For kidney transplant patients, it is necessary to ensure that all labs and ancillary services are coordinated for a successful surgery.
• Coordinates schedules with outside vendors that support the physicians including ENT and Urology for any surgeries that require such services.
• Coordinates surgeries with other surgeons including Plastic, Neurology and Pulmonology 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.

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.
• Experience with ICD 10 and CPT coding
• Strong knowledge of clinical/medical practice operations, procedures, terminology, and administrative procedures Until all children are well.

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.