Insurance Authorization Coordinator

Socket.dev; San Antonio (TX); On-site; USD 60,000 - 90,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401(k) with match

Paid time off

Career development

Health savings account

Employee Assistance Program

Pet insurance

Job summary

Baptist Health System Hospital in San Antonio, TX is seeking an RN Case Manager or Social Work professional to coordinate utilization management and post-acute services. Under the direction of the RN Case Manager or Social Work staff, you will verify patient demographics, obtain authorizations, follow up on discharge plans, and escalate variances to the Director of Case Management.

This role involves documenting all referrals in the Tenet Case Management system, collaborating with Patient

Qualifications

• Minimum education: High School diploma or equivalent.
• Preferred: Associate or Bachelor’s degree in a related field.

Responsibilities

• Coordinate utilization management and post-acute services.
• Validate patient demographics and payer information.
• Obtain and track required authorizations for status and level of care.
• Escalate disputes or denials to Director of Case Management.
• Document referrals and tasks in the Tenet Case Management system.
• Collaborate with Patient Access, Case Management, Managed Care and Billing to minimize delays.

Skills

Organizational skills

Verbal communication

Written communication

Problem solving

Computer literacy

Education

High School diploma or equivalent

Associate or Bachelor’s degree

Job description

The individual in this position works under direction of RN Case Manager and/or Social Worker. The individual’s

responsibilities include but are not limited to the following actions : a) Follow up on patient accounts when authorization for

stay is required , Fax numbers to Send clinical reviews b) Follow up on each account during the stay and on discharge for

authorization - document in the electronic system, c) Escalate any potential disputes or denial of accounts to Director of

Case Management or designee d) Trends disputed claims by at least payor and physician e) assist in obtaining authorization

for patient discharged to Skilled Facilities or other post-acute care that require authorization f) other duties as assigned

Responsibilities

General Functions

Utilization Management

Validates patient’s demographic and payer information with patient/family and notifies Patient Access immediately if any corrections are needed

Validates that all commercial/managed care discharges have an authorization for status and level of care provided and notifies Director of Case Management (DCM) or designee of variances

Cases that require authorization are obtained daily by fax or phone and documentation is completed daily

Escalate discharged cases at end of day that have no authorization or notification of dispute is provided by payor

Concurrently make sure all clinical needed by payors and updates are provided by alerting Case Manager assigned to case and escalating to DCM if not completed timely

Trend dispute/denial potential to DCM or designee by failure points in revenue cycle

Prepare denial information for UR Committee, Denial and Revenue Cycle Meetings

Collaborate with Patient Access, Case Management, Managed Care and Business office to improve concurrent review process to avoid denial or process delays in billing accounts (85% daily, essential)

Transition Management

Follow up on Authorization for post-acute services

Makes referrals for post-acute services under the direction of the RN Case Manager or Social Work (SW) staff utilizing the Tenet Case Management documentation system

Follow-up if referral requires an authorization by payor to discharge the patient

Completes tasks as assigned by RN or LVN Case Manager and/or SW staff

Makes copies, send faxes and complete phone calls to arrange post-acute services and to ensure that appropriate hospital information is communicated to post-acute providers

Documents all referrals and tasks in the Tenet Case Management documentation system per Tenet policy

Provides Important Message follow up letter to Medicare beneficiaries per Tenet policy and under the direction of the RN Case Manager or SW (10%daily, essential)

Compliance

Adheres to federal, state, and local regulations and accreditation requirements impacting case management scope of services

Adheres to department structure and staffing, policies and procedures to comply with the CMS Conditions of Participation and Tenet policies (5% daily, essential

Qualifications

MINIMUM EDUCATION: High School diploma or equivalent required.

PREFERRED EDUCATION: Associate or Bachelor’s degree

MINIMUM EXPERIENCE: Must have excellent organizational skills, excellent verbal and written communication

skills, demonstrated problem solving skills, and computer literacy.

PREFERRED EXPERIENCE: Acute hospital experience. Data Analytic skills.

REQUIRED CERTIFICATIONS/LICENSURE: N/A

PREFERRED CERTIFICATIONS/LICENSURE: Paramedic, EMT or Nursing Assistant

REQUIRED COURSES/ COMPLETIONS: N/A

PATIENT POPULATION/AGES SERVED: (√) Check all that apply

#LI-GF2

Baptist Health System Hospital is committed to providing exceptional patient care in a supportive and collaborative environment. As a member of our team, you will have the opportunity to work with advanced technology and be part of a healthcare community dedicated to making a positive impact on the lives of our patients.

At Baptist Health System, we understand that our greatest asset is our dedicated team of professionals. That’s why we offer more than a job – we provide a comprehensive benefit package that prioritizes your health, professional development, and work-life balance. The available plans and programs include:

• Medical, dental, vision, and life insurance
• 401(k) retirement savings plan with employer match
• Generous paid time off
• Career development and continuing education opportunities
• Health savings accounts, healthcare & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, auto & home insurance

Note: Eligibility for benefits may vary by location and is determined by employment status

Baptist Health System has more than 120 years history of caring for our community and making a positive difference. Our system of care includes six full-service hospitals, a specialized childrens hospital with a dedicated pediatric emergency unit, a comprehensive cancer care network, fitness and rehabilitation centers, a physician network, imaging centers, ambulatory services and the Baptist School of Health Professions. Wherever you go in the Baptist Health System, youll find that we have the same goal to help people achieve health for life through compassionate service inspired by faith. Join our team!