LPN Authorization Coordinator

Glenwood Regional Medical Center; West Monroe (LA); On-site; USD 45,000 - 68,000; Full time

Job summary

Glenwood Regional Medical Center in West Monroe, LA, seeks a skilled authorization coordination professional to support case management and UR activities. The role involves obtaining payor authorizations, submitting clinical information, and escalating denials to ensure timely placements and compliant care.

You will collaborate with UR nurses, case managers, physicians and patient access teams, maintain documentation in the Care Management system, and uphold confidentiality while meeting

Qualifications

• Excellent written and verbal communication skills.
• Experience with Microsoft Office applications (Word, Excel, Outlook).
• Experience with EMR systems strongly preferred.
• Demonstrates initiative and pro-active problem solving.
• Strong organizational skills and attention to detail.
• Ability to work independently with minimal supervision.

Responsibilities

• Validate daily that managed care/commercial cases have appropriate authorization and notify supervisor of variances.
• Document authorization and denial information in Care Management documentation system.
• Submit initial clinical information within 24 hours of admission as directed by UR nurse.
• Ensure payors have all clinical information and updates; alert UR nurse/DCM as needed.
• Coordinate peer-to-peer arrangements between physicians and insurance providers on denials and document outcomes.
• Maintain confidentiality of patient and hospital information.
• Perform other duties as assigned.
• Maintain licensure/certification (LPN) as required.

Skills

Communication skills

Microsoft Office

EMR experience

Initiative

Organization

Independent work

Education

Louisiana LPN license

Job description

Position Summary

Communicates with payors to obtain authorization for all patients as required and pending post-acute placement. Provide clinical information to payors as required under the direction of UR nurse. Documents authorization numbers, concurrent denials, attempts to overturn denials. Coordination of concurrent denial appeals between physicians and insurance providers. Collaborates with Patient Access, Case manager, UR nurse and physicians to facilitate obtaining authorizations. Timely escalates any potential disputes or denials to Director of Case Management or UR nurse.

Position Summary

Communicates with payors to obtain authorization for all patients as required and pending post-acute placement. Provide clinical information to payors as required under the direction of UR nurse. Documents authorization numbers, concurrent denials, attempts to overturn denials. Coordination of concurrent denial appeals between physicians and insurance providers. Collaborates with Patient Access, Case manager, UR nurse and physicians to facilitate obtaining authorizations. Timely escalates any potential disputes or denials to Director of Case Management or UR nurse.

Duties And Responsibilities

• Validates daily that all Managed care/Commercial cases have an appropriate authorization and notify DCM or UR nurse of variances
• Document authorization and denial information in Care Management documentation system
• Submits initial clinical information within 24 hours of admission as directed by UR nurse
• Concurrently make sure all clinical needed by payors or updates provided by alerting UR nurse and/or DCM
• Coordinate Peer-to-Peer arrangements between physicians and insurance providers on denials when appropriate and document outcome
• Maintains confidentiality of patient/physician/personnel information/hospital proprietary information
• Performs other duties as assigned
• Maintains licensure/certification, BLS, etc. as required

Education And Experience

• Experience with Microsoft Office, Word, Excel, and Outlook required
• Experience with EMR strongly preferred
• Manages time effectively, sets priorities, and consistently meets deadlines
• Excellent communication skills, both written and oral required
• Demonstrates initiative and pro-active approach to problem resolution
• Demonstrates good organizational skills and attention to detail
• Ability to work independently with little supervision
• Louisiana licensed LPN required
• 2 to 4 years' healthcare experience preferred

Please indicate whether you have ever been convicted of a crime, including any misdemeanors and/or DUI/DWI. (Criminal conviction(s) will not automatically exclude you from consideration for employment).