Day Shift Authorization Navigator – Healthcare Revenue Cycle

Stanford Medicine 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 to manage day-to-day financial clearance for scheduled services. You will advise on authorization questions and support departments with complex referral issues, ensuring high-quality customer service in line with PCARES practices.

Reporting to the Authorization Assistant Manager or Supervisor, you will track statuses, work with providers, and resolve payer problems while maintaining compliance with department policies

Qualifications

• 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, and Children's Health Programs.

Responsibilities

• Act as a patient and family advocate between obtaining information from providers and fulfilling payer requirements.
• Collaborates with providers and staff to promote referrals and authorizations.
• Tracks and notes patient accounts on authorization status and payer issues; prioritizes clinically urgent cases.
• Processes authorizations with denials, peer-to-peer, or medical justification requirements.
• Follows up on authorizations needing further research or resubmission.
• Ensures claims edits are cleared timely per standards.
• Investigates and resolves insurance issues with stakeholders as needed.
• Coordinates with contracting for letters of agreements for non-LPCH coverage.
• Notifies management of possible deferrals/denials of elective services.
• Communicates with access nurse or clinician for triage and issue resolution.

Skills

Operational problem solving

Effective communication

Interpersonal collaboration

Computer systems knowledge

Medical terminology

Healthcare payer knowledge

Education

High school diploma or GED

Job description

Stanford Medicine Children's Health is seeking an Authorization Coordinator to manage day-to-day financial clearance for scheduled services. You will advise on authorization questions and support departments with complex referral issues, ensuring high-quality customer service in line with PCARES practices.

Reporting to the Authorization Assistant Manager or Supervisor, you will track statuses, work with providers, and resolve payer problems while maintaining compliance with department policies