Prior Authorization Coordinator RCM

VITAS Healthcare; United States; On-site; USD 38,000 - 52,000; Full time

Benefits offered by this job

Health insurance

401(k) plan

Paid Time Off

Life insurance

Job summary

VITAS Healthcare is seeking a Prior Authorization Coordinator in Miramar, FL. The role supports efficient insurance verifications, authorizations, and revenue cycle processes, ensuring accurate patient data and timely approvals.

Typical schedule is weekdays, with the option to work from home on Fridays after 90 days. This hybrid on-site role involves collaboration with care teams and administrative staff to meet payor requirements and improve reimbursement outcomes.

Qualifications

• Two years of related healthcare Revenue Cycle experience.
• Understanding of medical terminology and clinical documentation.
• Knowledge of insurance verification and authorization impact on Revenue Cycle.
• Customer service skills with internal and external customers.
• Ability to multitask in a dynamic work environment.
• Proficient in PC-based office tools.

Responsibilities

• Ensure quality and accuracy of patient insurance information and that listed certification periods, billing addresses, policy numbers, authorization numbers are entered correctly.
• Prioritize and process incoming Insurance Verifications and Prior Authorization requests.
• Verify Medicaid, private insurance, and self-pay payor sources via telephone or online systems.
• Obtain authorization from private insurance and other payors via telephone, fax, or online systems while maintaining confidentiality.
• Maintain authorizations extension for all patients as appropriate.
• Refer authorization requests requiring clinical judgment to Prior Authorization Supervisor.
• Enter all hospice benefit information into Registration Tool and patient accounting system.
• Respond to calls, emails and other inquiries regarding status of referrals and/or authorization information.
• Provide other administrative support to the department as needed.
• Complete Payor Information Form and Payor Change Request Forms as needed.
• Update Contracting Coordinator of payor information changes.
• Coordinate with members, providers and key departments to promote understanding of Prior Authorization, Referral, and Insurance Verification requirements.
• Communicate efficiently to resolve issues pertaining to the verification and authorization processes.
• Access Medicare's Common Working File (CWF) to verify eligibility if applicable.

Education

High School diploma or GED

Tools

Microsoft Outlook

Microsoft Excel

Job description

Prior Authorization Coordinator position is located in Miramar, Florida. Must be able to work Monday through Friday, 8:30am-5pm or 9am-5:30pm. After 90 days, you will be able to work from home on Fridays.

• Ensures quality and accuracy of the patient insurance information and that listed certification periods, billing addresses, policy numbers, authorization numbers, etc. are all entered correctly.
• Prioritizes and processes incoming Insurance Verifications and Prior Authorization requests.
• Verify the patient’s Medicaid, private insurance, and self-pay payor sources via telephone, or online systems.
• Obtain authorization from private insurance and all other payor sources requiring authorization via telephone, facsimile, or online systems while maintaining compliance to medical record confidentiality regulations.
• Maintains authorizations extension for all patients as appropriate.
• Refers authorization requests that require clinical judgment to Prior Authorization Supervisor and clinical support staff.
• Obtain information from agencies when necessary to assist with receiving authorizations and re-authorizations from private insurance and all other payor sources.
• Assist other departments and Care Centers in the efficient collection of client and payor information to ensure accuracy.
• Enter all hospice benefit information into Registration Tool and patient accounting system.
• Respond to calls, emails and other inquiries regarding the status of outstanding referrals and/or authorization information.
• Provides other administrative support to the department as needed.
• Complete Payor Information Form (PIF) and Payor Change Request Forms (PCR) when needed for the purpose of meeting payor and client's needs to ensure accurate reimbursement.
• Update Contracting Coordinator of payor information changes.
• Coordinates with members, providers and key departments to promote an understanding of Prior Authorization, Referral, and Insurance Verification requirements and processes.
• Communicate efficiently, effectively, and timely to resolve issues pertaining to the verification and authorization processes.
• Access Medicare's Common Working File (CWF) to verify eligibility in the event a patient has termed coverage with private insurance carrier if applicable.

QUALIFICATIONS

• At least two years of related healthcare Revenue Cycle experience, preferably within registration and financial clearance.
• Understanding of medical terminology and clinical documentation.
• Clear understanding of the impact insurance verification and prior authorization has on Revenue Cycle operations and financial performance.
• Demonstrated knowledge of commercial insurance carriers' guidelines and criteria of verification, authorization and reimbursement.
• Demonstrated knowledge of customer service skills when responding to questions and other inquiries from internal and external customers.
• Ability to prioritize and manage multiple tasks simultaneously, and to effectively anticipate and respond to issues as needed in a dynamic work environment.
• A demonstrated ability to use PC based office productivity tools (e.g. Microsoft Outlook, Microsoft Excel) as necessary; general computer skills necessary to work effectively in an office environment.
• Ability to prioritize and effectively anticipate and respond to issues as they arise.

EDUCATION

• High School diploma or GED required

SPECIAL INSTRUCTIONS TO CANDIDATES

EOE/AA M/F/D/V

VITAS® Healthcare is the nation’s leading provider of end-of-life care, and has the resources and expertise to support your personal and professional growth. As a member of the VITAS team, you’ll find fulfillment working for a people-focused organization dedicated to making a difference in the lives of others. You will be more than just an employee: You will be counted on as an expert in your field, and as a valued team member whose efforts are respected and vital to our hospice mission.

All VITAS employees commit to fulfilling their duties and responsibilities with the highest regard for professionalism, collaboration and teamwork, and an eye focused constantly on growth and improvement. We serve with commitment and compassion, and position ourselves for the future by embracing, innovating, and leading change. If you are that person, make your voice heard—find your purpose at VITAS today.

Benefits Include:

• Competitive compensation
• Health, dental, vision, life and disability insurance
• Pre-tax healthcare and dependent care flexible spending accounts
• Life insurance
• 401(k) plan with numerous investment options and generous company match
• Cancer and/or critical illness benefit
• Tuition Reimbursement
• Paid Time Off
• Employee Assistance Program
• Legal Insurance
• Roadside Assistance
• Affinity Program

Many of our positions offer the opportunity to work day or night shifts, weekdays or weekends.

Choose a Career with VITAS