Practice Coordinator III #7 of 3880

University of California - San Francisco; Emeryville (CA); On-site; USD 70,000 - 100,000; Full time

Job summary

UCSF Medical Center is seeking a PC Authorization Coordinator to secure financial clearance for patients, providers, and the health system. You will work with administrative, clinical, and management teams to support operations and improve revenue cycle through efficient authorizations.

You will handle pre-authorization activities, review denials, and manage authorization work queues in Epic/APeX, ensuring accurate coding and timely processing.

Qualifications

• Experience with medical billing and authorizations.
• Familiarity with Epic/APeX and payer communications.
• Strong attention to detail and customer service.

Responsibilities

• Review and process authorization work queues daily.
• Verify insurance and eligibility for patients and referrals.
• Coordinate surgical and outpatient authorizations across services.
• Communicate authorization status to patients, providers, and staff.
• Enter CPT and ICD-10 codes accurately for billing and reporting.

Skills

Healthcare billing

Authorizations

Epic APEx / APeX

Payor communications

Customer service

Tools

Epic (APeX)

Job description

As a patient-focused organization, UCSF Medical Center exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. UCSF Medical Center seeks faculty and staff that are committed to the values of professionalism, respect, integrity, diversity, and excellence that are integral to our mission.

The PC Authorization Coordinator is primarily responsible for securing financial clearance for the patient, provider, and health system. The coordinator works closely with the administrative, clinical and management teams to support practice operations and customer service recovery and intervention efforts. Provides support for financial clearance functions including authorizations, PAFRs, LOAs billing and RFIs.

Under the direction of the Revenue Manager and/or supervisor, the biller/auth rep will work independently to resolve billing related issues in APeX (Epic) to help maximize payor reimbursement and RVU charge capture. He/she must have an advanced understanding of healthcare terminology, processes and workflow and healthcare billing/authorizations in order to make good decisions and resolve account issues. The incumbent should also have outstanding people skills, including telephone technique, professional appearance, organizational skills, and communication skills (oral and written).

This position will also be responsible for performing detailed review of medical record documentation to answer billing/authorization level questions and will be responsible for working assigned authorization and billing work queues (WQs) on a daily basis to assist in keeping the denials at a minimum. He/she must have the ability to prioritize multiple tasks and work well with all levels of staffing including faculty, management, and coworkers both within and outside of the unit.

The PC is responsible for the maintenance of all routine clerical operations and communications. Adheres to the UCSF House and Telephone Standards and is sensitive to the needs of patients, staff and providers at all times. The PC is a team player who works closely with others and who is flexible in dealing with the changing priorities. Requires a self-reliant individual who synthesizes knowledge of practice operations in order to problem-solve, prioritize and facilitate complex transactions in the course of daily activities.

This position makes a difference for patients in an outpatient care unit by providing excellent customer service, facilitating and ensuring the accuracy of the information flow between medical, hospital staff and departments to maximize unit efficiency. The PC is required to work at any UCSF campus as needed and scheduled.

DUTIES & ESSENTIAL JOB FUNCTIONS

New & Follow-Up Patient Authorizations 5%

• On a daily basis review and works authorization work queues documenting activities within the authorization record.

• Reviews referral work queues as needed to monitor incoming volume.

• If a practice utilizes an external system for specialty authorizations, such an electronic log, the representative maintains the electronic log but also creates an authorization record for accurate tracking and documenting financial securitization.

• Enters or updates patient registration information as needed to correct errors.

• Ensure appropriate insurance is loaded and facilitates authorization acquisition. Verifies insurance and referral/authorization information from previous appointments as needed to facilitate subsequent authorizations. Schedules and coordinates any pre-appointment tests or appointments.

• Schedules and coordinates any pre-appointment tests or appointments.

• Creates HARs [Hospital Account Records] as needed to facilitate authorization loading.

• Creates a professional and positive first impression for patients and referring physicians.Demonstrates good judgment and common sense.

Advanced New & Follow-Up Patient Authorizations 15%

• Secures outside medical records, as needed for authorizationsmakes quick determination on services known for long authorization turn around or not needing the authorization. as to which physician can best evaluate the patient.

• Understands and is able to prioritize authorizations based on clinical complexity, diagnosis and current treatment status to ensure authorizations are prioritized appropriately. Has expertise in understanding payor timelines to know when authorizations need to be started urgently due to payor constraints and ensure that as many patients are authorized successfully as possible.
• Informs practice personnel, providers are patients as needed of authorization delays and denials in a timely manner.

• Escalates authorization delays ASAP for services to patients within 72-hour window or for urgent or medically sensitive services.

Surgical Authorization Coordinator 5 % * depends on practice

• Coordinates securing authorizations for all outpatient and inpatient surgeries for the surgical practice.

Captures appropriate CPT and ICD-10 codes, or coordinates with provider, or certified professional coder to acquire accurate codes.

• Interacts with clinical and academic staff to coordinate surgical activities depending on authorization availability.

• Coordinates and manages complex referrals and authorizations including LOAs, Psych, Lab, Imaging and other specialties.

Advanced Surgical Authorizations 15%

• Coordinates with practices, PAR, Admitting and other related departments to coordinate securing all necessary authorizations. This could include procedure, admissions, medications, labs, imaging and testing services. Additionally, many cases require complex admission, discharge and planning coordination involving hospital reservations and authorizations related to study patients on protocol, transfers from outside hospitals and post transfer urgent authorizations and surgical planning.

• Works with patients and staff to confirm availability and accuracy of medical information within APeX and to ensure documentation supports medical necessity.
• Secures authorization for surgical procedures and coordinates with Hospital Admissions Department as needed. Acts as primary liaison to procedure billing team to coordinate updated authorizations and or TARs for mid procedure changes or additions.
• Ensures compliance with Medical Center bylaws and Regulations ensuring the diagnosis is confirmed before authorization through formal review of relevant clinical information.The authorization coordinator is the sole person to ensure authorization is secured for the organization.
• Coordinates advanced authorization for complex services such as psychotherapy, psychiatry, IVF, serial service testing and imaging.
• Must have extensive payor expertise to coordinate complex authorizations for multiple surgical practices (i.e. Ortho Surgery, Urology Surgery etc.)Revenue Cycle<5%
• Ensure that authorizations are secured with accurate clinical information and with support for medical necessity.
• Communicates Medical Center administrative and financial policies clearly to patients, answering patient account questions and knowing when to refer patients to financial counseling, billing agents, patient relations or other support departments for additional help.
• Obtains and documents insurance authorizations for established patient visits, referrals and procedures or ancillary services. Communicates clinical information from medical records authorization requests to insurance companies.
• Demonstrates competency working with CPT codes and ICD-9 and ICD-10 for the purpose of scheduling and securing authorization.
• Works with patients and staff to confirm availability and accuracy of medical information within APeX and to ensure compliance with all hospital policies and procedures.

• Able to identify and elevate outstanding issues to appropriate supervisor or manager.

• Addresses patient billing questions and triage calls as needed.

Provides requested documentation such as operative reports, doctor's notes and insurance information to aid in the reimbursement process.

• Obtains retro authorizations of procedures while maintaining current list of those insurances with a history of denials (this includes pre-service, post service, retro/modifications and appeals if needed.)

Moderate Complex Revenue Cycle 5%

• Monitors provider(s) open authorizations to ensure that patient services can be rendered in a timely manner and meeting clinical timelines as much as possible.
• Works RFI work queues to secure information for accurate billing submissions or to respond to denials such as retro authorizations, clinical documentation, and addended authorizations with add on CPT codes.
• Secures authorization for procedures, specialty visits and ancillary testing and coordinates with Hospital Admissions Department as needed.
• Secures assistance with complex DME authorizations that often require precise documentation in specific formats to receive approval

• Provides assistance with medication authorization for new medications and refills.

Advanced Revenue Cycle 15%

• Secures complex insurance authorizations for services, medications, or testing and is able to track the authorizations for renewal based on insurance company driven limits of time frames or numbers of visits or services.
• Has demonstrated competency working with HCPC codes and is able to look up and locate the appropriate codes for the purpose of requesting authorization (e.g. J codes for medications like chemotherapy).
• Understands how to identify and interpret a patient's insurance benefit package, including pharmacy and mental health carve outs. Utilizes this information to direct authorization requests and to coordinate these services for patients.
• Reviews & analyzes monthly denial reports for both professional and hospital billing. Initiatives retro authorizations from denial report.
• Identifies trends in denials and works with practice team and supervisors to develop and implement improved workflows to minimize