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

Vitas Healthcare Corporation; United States; Remote; USD 65,000 - 85,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Life insurance

401(k) plan

Job summary

VITAS Healthcare is seeking a Prior Authorization Coordinator to ensure accurate patient insurance data and timely authorizations, with on-site work in Miramar, FL.

The role includes handling insurance verifications, authorizations, and payer communications to support Revenue Cycle and other departments while maintaining patient confidentiality.

Qualifications

• At least two years of related healthcare Revenue Cycle experience.
• 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.

Responsibilities

• 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 terminated coverage with private insurance carrier if applicable.

Skills

Insurance verification

Prior authorization

Customer service

Microsoft Excel

Medical terminology

Education

High School diploma or GED

Tools

Microsoft Outlook

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 terminated 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