Prior Authorization & Eligibility Coordinator

Luminis Health, Inc.; Annapolis (MD); On-site; USD 24,000 - 36,000; Full time

Benefits offered by this job

Medical, Dental, and Vision Insurance

Retirement Plan with employer match

Paid Time Off

Tuition Assistance

Job summary

Anne Arundel Medical Center is hiring a Coordinator for Pre-Authorization Verification & Eligibility (PAVE) to manage pre-certifications, verify insurance eligibility, and coordinate with payers, patients, and clinical staff at LH facilities.

The role requires strong analytical skills, experience in medical billing or patient access, and proficiency with Microsoft Office. A minimum two-year background in revenue cycle activities is preferred, with Epic knowledge advantageous.

Qualifications

• Minimum two (2+) years of experience in Medical Billing, Hospital Patient Access, or Hospital Business Office in an automated setting.
• Knowledge of registration, verification, pre-certification, and scheduling procedures.
• Experience with Medical and Insurance terminology (ICD-10, CPT 4).
• Minimum of one (1+) year of demonstrated strong analytical skills.
• Proficiency with Microsoft Office and Outlook.
• Excellent verbal and written communication skills.
• Preferred experience with the Epic Hospital Billing System.

Responsibilities

• Serve as primary resource for LH regarding insurance eligibility; prior authorization process and requirements; collects patient demographic information and coverage information.
• Contacts insurance companies by phone, fax, or online portal to obtain insurance benefits, eligibility, and authorization information.
• Updates systems with accurate information; performs quality assurance audits and reports back to leadership.
• Communicates with service line partners regarding rescheduling due to lack of authorization or limited benefits; approved by clinical personnel.
• Ensures proper authorization for inpatient, elective, outpatient, surgical, urgent/emergent services and timely notification to payers.
• Documents all benefits, authorizations, and financial obligations clearly to expeditious processing of patient accounts and denial prevention.
• Maintains close working relationships with clinical partners to facilitate sending clinical information to payer for authorization.
• Monitors team mailbox, e-mail inbox, faxes, and phone calls related to PAVE accounts within defined time frames.
• Contacts payers to obtain prior authorization and gather additional clinical/coding information as needed.
• Provides standardized documentation within the system to identify prior authorization criteria and ensure insurance requirements are met.
• Educates providers and clinical staff about the prior authorization process.
• Stays informed on insurance criteria for prior authorization; attends staff meetings, education sessions, and mandatory trainings.
• Performs other duties as assigned by PAVE Leadership.

Skills

Medical Billing

Patient Access

Communication

Analytical Skills

Microsoft Office

Education

Associate degree in Accounting/Finance/Business or Healthcare

Revenue Cycle experience in lieu of degree

Tools

Epic Hospital Billing System

Job description

Anne Arundel Medical Center is hiring a Coordinator for Pre-Authorization Verification & Eligibility (PAVE) to manage pre-certifications, verify insurance eligibility, and coordinate with payers, patients, and clinical staff at LH facilities.

The role requires strong analytical skills, experience in medical billing or patient access, and proficiency with Microsoft Office. A minimum two-year background in revenue cycle activities is preferred, with Epic knowledge advantageous.