Authorization Coordinator / Greater Manchester Region Admn

Hartford HealthCare; Manchester (CT); On-site; USD 42,000 - 54,000; Full time

Job summary

Hartford HealthCare is seeking an insurance authorization specialist in Manchester, CT. The role requires ensuring precertifications and authorizations are in place for outpatient services, working with FCC, ASC scheduling and physician offices to prevent denials and improve cash flow.

The ideal candidate has a High School diploma (Associate’s degree preferred), 2 years in hospital or medical office insurance/authorization experience, and strong English communication skills for coordinating care

Qualifications

• High School degree required.
• Associate’s degree preferred.

Responsibilities

• Obtain and document insurance eligibility and benefits in ADT system.
• Obtain authorizations prior to date of service, coordinating with physicians’ offices.
• Verify coverage, manage pre-authorizations to prevent denials and ensure payment.
• Assign CPT and diagnostic codes (CPT/ICD-9CM/ICD-10) in billing system.
• Communicate with Case Management and Behavioral Health to secure necessary authorizations.
• Ensure accurate insurance information and referrals on patient accounts.

Skills

Insurance knowledge

CPT/ICD-10 codes

Medical terminology

English communication

Customer service

Deadlines/fast-paced environment

Education

High School degree

Associate’s degree preferred

Tools

Meditech system

Job description

• Associate’s degree preferred.

Location Detail: 71 Haynes Street (10627)

Shift Detail: M-F 8-5:30

Description - External

Work where every moment matters.

Every day, over 40,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut’s most comprehensive healthcare network.

The Greater Manchester Region has approximately 2,500 employees. It includes Manchester Memorial Hospital, a 249-bed community hospital, Rockville General, a campus of Manchester Memorial Hospital, a 102-bed facility, a large multispecialty provider group and visiting nurse services. The Greater Manchester Region serves a region of 300,000 people in 19 towns.

Position Summary

This position reports to the Manager, Central Authorization Center and works directly with FCC, ASC scheduling and physician’s offices to ensure all required approvals, precertification/ authorizations are in place to proceed with the scheduled patient services for outpatient ancillary departments. Verifies receipt of patient insurance information, including managed care authorizations; follows up to obtain missing patient and/or insurance pre-authorization data as required. Researches and resolves reasons for insurance and Medicare claim denials, initiates needed code and billing corrections when appropriate to ensure payment receipt for services provided. This position is responsible for monitoring and obtaining all inpatient and outpatient admissions and procedures.

Qualifications

Qualifications - External

Education/Certification

• High School degree required.
• Associate’s degree preferred.

Experience

• 2 years Hospital or medical office insurance/ authorization /precertification/referral work experience.
• 2 years customer service.

Competencies

• Knowledge of Medical Insurance and authorization process.
• Current with CPT and ICD-10 Codes.
• Medical Terminology knowledge.
• Must have excellent English written and verbal skills, basic computer and keyboard skills for use of the Meditech system.
• Customer service.
• Experience in meeting deadlines in fast paced multitasking environment.

ESSENTIAL DUTIES And RESPONSIBILITIES

Disclaimer: Job descriptions are not intended, nor should they be construed to be, exhaustive lists of all responsibilities, skills, efforts or working conditions associated with the job. They are intended to be accurate reflections of the principal duties and responsibilities of this position. These responsibilities and competencies listed below may change from time to time. Eastern Connecticut Health Network reserves the right to change or assign other duties and responsibilities to this position

• Obtains Insurance eligibility and benefits and documenting in ADT system. (prior to date of service and or upon admission).
• Notification of admissions to insurance carriers by various methods: online, telephonically, by fax, as needed to ensure notification requirements are met in a timely manner preventing any denials and nonpayment of services.
• Obtains authorizations prior to date of service. Working closely with physician offices to ensure authorizations are obtained by 2pm day before surgery /service. Notifies OR Director of any issues of accounts without authorizations and possible cancelations due to no auth obtained.
• Documents clearly in ADT system authorizations, issues, etc.
• Works closely with Case Management and Behavioral Health communicating necessary information to ensure authorizations for admissions obtained.
• Monitors authorizations obtained and documented ensuring conditions of notification have been met and denials are prevented.
• Verifies insurance policy benefit information and obtains Authorization/Precertification prior to the patient’s visit, scheduled surgery, procedure or admission, and/or immediately following the admission.
• Assists in identifying problems and ensures that the insurance is accurate on the patient’s account.
• Assures insurance information and appropriate referrals have been completely and accurately obtained.
• Responsible for eligibility denial management ensuring accurate insurance information by making corrections on patient accounts received from claim rejections or eligibility failures.
• Reviews patient documentation to assure that proper managed care pre-authorizations have been obtained where required. When necessary, follow up with personnel in the ordering Doctor’s office to obtain missing authorization or insurance information. Relays important pre-authorized managed care coverage information to the Radiologists in order to avoid non-payment for services provided that were not pre-authorized.
• The incumbent assigns proper procedural codes to reports and inputs Current Procedural Terminology (CPT) and diagnostic codes into the billing system for all related services provided. Assures documentation for Hospital and Clinic Radiology services is complete and accurate with appropriate (CPT) codes and diagnostic (ICD-9CM, and ICD-10) codes.

We take great care of careers.

With locations around the state, Hartford HealthCare offers exciting opportunities for career development and growth. Here, you are part of an organization on the cutting edge - helping to bring new technologies, breakthrough treatments and community education to countless men, women and children. We know that a thriving organization starts with thriving colleagues-- we provide a competitive benefits program designed to ensure work/life balance. Every moment matters. And this is your moment.