Prior Authorization Coordinator RCM- 8:30am- 5:30pm

Vitas Healthcare Corporation; Town of Florida (NY); On-site; USD 52,000 - 68,000; Full time

Job summary

Vitas Healthcare Corporation is seeking a Prior Authorization Coordinator to ensure accurate insurance data, maintain authorizations, and support efficient revenue cycle operations. The role is based on-site at our Miramar, Florida corporate office with a hybrid schedule (Mon-Fri 8:30/9:00–5:00/5:30).

The coordinator will verify payor sources, obtain authorizations, assist departments, and manage payer information to ensure proper reimbursement and compliance.

Qualifications

• Two years of healthcare Revenue Cycle experience, preferably in registration/financial clearance.
• Understanding of medical terminology and clinical documentation.
• Knowledge of how insurance verification and prior authorization impact Revenue Cycle operations.
• Experience with commercial insurance carriers' guidelines for verification and reimbursement.
• Strong customer service skills when handling internal and external inquiries.
• Ability to prioritize and multitask in a dynamic work environment.
• Proficiency with PC-based office tools (Outlook, Excel) and general computer skills.

Responsibilities

• Prioritize and process incoming Insurance Verifications and Prior Authorization requests.
• Verify Medicaid, private insurance, and self-pay payor sources via phone or online systems.
• Obtain authorizations from private insurers and other payors as required.
• Maintain authorizations extensions for all patients when appropriate.
• Refer complex requests to the Prior Authorization Supervisor and clinical staff.
• Coordinate with agencies to assist with obtaining authorizations and re-authorizations.
• Assist other departments in collecting client and payor information for accurate reimbursement.
• Enter hospice benefit information into Registration Tool and patient accounting system.
• Respond to calls, emails, and inquiries regarding status of referrals and authorizations.
• Provide administrative support to the department as needed.
• Complete Payor Information Form (PIF) and Payor Change Request Forms (PCR).
• Update contracting personnel on payor information changes.
• Coordinate with members, providers, and departments to explain PA, referral, and verification requirements.
• Communicate efficiently to resolve issues in verification and authorization processes.
• Access Medicare's Common Working File (CWF) to verify eligibility when applicable.

Skills

Revenue Cycle

Medical Terminology

Insurance Verification

Customer Service

MS Office

Multitasking

Office Productivity Tools

Education

High School diploma or GED

Tools

Microsoft Outlook

Microsoft Excel

Registration Tool

Job description

Prior Authorization Coordinator RCM ensures the quality and accuracy of the patient insurance information and that listed certification periods, billing addresses, policy numbers, authorization numbers, etc. are all entered correctly. Must be able to work on-site in the Corporate Miramar, Florida office, Monday through Friday, 8:30am-5:00pm or 9:00am-5:30pm. Hybrid schedule.

• 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