Patient Access Coordinator (Pre-Authorization)

Agendia Inc.; Irvine, Sayreville (CA, NJ); On-site; USD 40,000 - 65,000; Full time

Job summary

An established industry player is looking for a Patient Access Coordinator to streamline the authorization process for incoming medical orders. This role is crucial in ensuring that all necessary documentation is collected and submitted promptly to payors, maximizing approval chances. You'll collaborate with various departments and external clients, showcasing your strong organizational skills and attention to detail. This position offers a unique opportunity to work in a dynamic environment where your contributions directly impact patient access to essential services. If you thrive in fast-paced settings and have a passion for healthcare, this role is perfect for you.

Qualifications

• 1+ years of experience in medical pre-authorization and billing.
• Ability to understand medical payer policies and documentation.

Responsibilities

• Request and manage authorizations for incoming orders.
• Communicate with physicians and sales teams for documentation.
• Log and track authorization submissions and follow up.

Skills

Medical Pre-Authorization knowledge

Knowledge of CPT codes

Knowledge of ICD 10 codes

Medical billing experience

Organizational skills

Customer service skills

Analytical thinking

Education

High School diploma

1+ years related experience

Job description

Description

AIM OF THE POSITION

The Patient Access Coordinator is responsible for requesting authorization for all applicable incoming orders. This process includes understanding of payers’ medical policies for our services, collecting and reviewing all the necessary documentation required to submit prior authorization, contacting the ordering physician or their office for additional information if applicable, completing the required authorization submission forms within allotted timeframes and, follow-up with the payor to obtain an authorization determination. When applicable, the PA Coordinator will also submit a Prior Authorization appeal if criteria is met but the PA was denied erroneously.

POSITION WITHIN THE ORGANIZATION

1. Customer Care, Sales, Commercial and external vendors

2. Cooperates with all departments across the organization

Requirements

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Reviews incoming orders to determine if authorization is required

• Reviews documentation from ordering physician for completeness to meet the medical policies of payors and work them in priority dependent on allotted timeframes per payer as the time can vary.

• Contacts ordering physician's office to obtain missing documentation when applicable or to meet timeliness of the submissions

• Communicate with physician offices and/or sales team for assistance with authorization submissions, when applicable

• Verifies diagnosis code on order in line with current ICD 10 requirements

• Completion of authorization forms via paper or online

• Submit authorizations to payors via fax, through payor portal, or third party vendor with all required documentation to maximize success in achieving approvals

• Log authorization actions within the billing system for tracking

• Follow up on all open authorization submissions including those submitted by the third party vendor

• Notify billing staff and document account when authorization determination is received

• Additional tasks as needed

The above listing represents the general duties considered essential functions of the job and is not to be considered a detailed description of all the work requirements that may be inherent in the position.

KEY CONTACTS

• Internal: This position may interface with various departments within the company.

• External: Clients and Payors

EDUCATION AND EXPERIENCE REQUIREMENTS

EDUCATION:

• High School diploma or general education degree

• 1 + years related experience preferable

KNOWLEDGE, SKILLS AND ABILITIES (KSA’S)

Specific Knowledge Required:

Knowledge: Comprehension of a body of information acquired by experience or study. Skill: A present, observable competence to perform a learned activity.

Ability: Competence to perform an observable behavior.

• Medical Pre-Authorization knowledge/experience 1 + years

• Knowledge of CPT and ICD 10 codes

• Previous medical billing experience preferred

• Ability to read and understand medical payer policies as well as pathology reports

• Ability to work with sensitive and confidential information

BEHAVIOURAL COMPETENCIES/DESIRED SKILLS

• Must be able to work in a fast-paced environment

• Must have strong organizational skills and attention to detail

• High degree of accuracy

• Manage Multiple tasks independently

• Excellent problem resolution

• Excellent customer service skills

• "Outside the Box" thinker

• Other Skills necessary: Analytical thinking, thoroughness, good research skills, and strong verbal/written communication.

· PRIVACY NOTICE: To review the California privacy notice, click here: https://agendia.com/privacy-policy/

· Employees must not be classified as an excluded individual who is prohibited from participation in any Federal health care program.

WORKING ENVIRONMENT

Establishes ADA (Americans with Disabilities Act) requirements

ENVIRONMENT/SAFETY/WORK CONDITIONS

Working conditions (inside or outside the office)

• General office environment. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Maintains a clean, neat, and orderly work area.

• Adheres to Department Specific Safety Guidelines.

• Standing, sitting, walking, bending, reaching, manual manipulation, and lifting up to 15 pounds.

TRAVEL

No travel is required.

OTHER DUTIES

Other duties as required by management