Patient Care & Authorization Coordinator

UNMH Jobs; Albuquerque (NM); On-site; USD 45,000 - 60,000; Full time

Job summary

UNMH Jobs in Albuquerque, NM is seeking an organized coordinator for the Operating Room - CCT to manage patient appointments and support services. You will interface with insurance payors on pre-authorizations, abstract charts with CPT/ICD/HCPCS codes, and assist in denials appeals while advocating for patients.

Collaboration with staff and physicians is essential. The role requires experience in clinical coordination, strong communication, and a patient-centered approach to care.

Qualifications

• High School or GED Equivalent
• Course
• Medical Terminology Course w/in Six Months of Position
• 2 years directly related experience
• Bilingual English, Spanish, Keres, Tewa, Tiwa, Towa, Zuni, or Navajo

Responsibilities

• PATIENT CARE - Assist patients in locating departments; schedule and coordinate patient appointments; refer patients and families to appropriate services and resources
• PRIOR AUTHORIZATION - Complete pre-screening process for specialty clinic appointments for referral and/or prior auth
• PRIOR AUTHORIZATION - Verify coverage eligibility on patients needing prior authorization
• CODING - Abstract chart information and assign CPT, ICD, and HCPCS codes for purpose of predetermination or prior authorization
• LIAISON - Perform as liaison between clinic staff, providers, and the insurance company or other payors to coordinate financial benefits/ coverage and prior authorizations
• DOCUMENTATION - Complete and fax paperwork and pertinent medical documentation to insurance companies and other payors for approval; document final prior authorization in financial systems
• FINANCIAL ASSISTANCE - Refer self-pay patients for financial assistance; make financial assistance appointments
• COORDINATION - Coordinate with hospital and clinic surgical representatives, providers, and other applicable areas for day surgery prior authorization and/or financial coverage or assistance
• TRAINING - Perform outreach/training with clinical areas to ensure process flow remains tight and to maintain open communication
• DENIALS - Track and investigate payment denials due to 'no authorization'; report detail information to supervisors and work with billing office representatives to coordinate appeal efforts
• CUSTOMER SERVICE - Identify Primary Care Physicians for all patients and communicate with the PCP as necessary; take messages for department personnel
• CUSTOMER SERVICE - Acquire prior patient records, patient billing, referral information and lab results
• CUSTOMER SERVICE - Assist referring providers in resolving problems, locate UNM physicians and forward documents
• PATIENT CARE - May assist clinical staff with routine non-invasive patient treatment procedures and initial screenings
• LEAD - May exercise functional and technical lead over lower level staff
• PATIENT SAFETY 1 - Follow patient safety-related policies, procedures and protocols
• PATIENT SAFETY 2 - Demonstrate proactive approach to patient safety by seeking opportunities to improve patient safety through questioning of current policies and processes
• PATIENT SAFETY 3 - Identify and report/correct environmental conditions and/or situations that may put a patient at undue risk
• PATIENT SAFETY 4 - Report potential or actual patient safety concerns, medical errors and/or near misses in a timely manner
• PATIENT SAFETY 5 - Encourage patients to actively participate in their own care by asking questions and reporting treatment or situations that they don't understand or may 'not seem right'
• PATIENT CENTERED MED - Adhere to and promote the core expectations of the Patient Centered Medical Home or Patient Centered Specialty Practice as applicable

Job description

UNMH Jobs in Albuquerque, NM is seeking an organized coordinator for the Operating Room - CCT to manage patient appointments and support services. You will interface with insurance payors on pre-authorizations, abstract charts with CPT/ICD/HCPCS codes, and assist in denials appeals while advocating for patients.

Collaboration with staff and physicians is essential. The role requires experience in clinical coordination, strong communication, and a patient-centered approach to care.