Remote Authorization Coordinator – Healthcare Finance

Stanford; Palo Alto (CA); Remote; USD 47,000 - 59,000; Full time

Job summary

Lucile Packard Children’s Hospital Stanford, part of Stanford Children’s Health, seeks an Authorization Coordinator to manage day-to-day financial clearance for scheduled services and serve as a resource on complex authorization issues. You will ensure high-quality customer service in line with hospital PCARES practices and policies.

The role reports to the Authorization Assistant Manager and requires collaboration with multiple departments to secure referrals and approvals while minimizing

Qualifications

• Education: High school diploma or GED equivalent.
• Experience: Two years of directly-related experience.
• Knowledge of Medicare, Medi-Cal, Workers Comp, Managed Care (HMO, PPO, POS, etc ), Children's Health Programs (CCS, GHPP, Healthy Families, etc ).

Responsibilities

• Act as a patient and family advocate between obtaining necessary information from providers and fulfilling payers' referral/authorization requirements.
• Collaborates with corresponding providers and staff members from service sites to promote the success of obtaining referrals and authorizations.
• Tracks and notes patient accounts on the authorization status, follow up and payer issues.
• Assists respective Authorization team members in prioritizing clinically urgent cases and secure authorizations in advance to minimize LPCH's potential financial risks.
• Processes and follows-up on authorizations that have denials, peer-to-peer or further medical justification requirements.
• Follows-up on and corrects authorizations that require further research, review, or resubmission.
• Ensures all authorization claims edits holding claims are cleared timely and effectively in accordance to department and organizational set metrics and authorization standards.
• Investigate, resolve and document insurance issues in a timely and efficient manner, and contact corresponding stakeholders as needed.
• Facilitates the coordination with contracting to obtain letters of agreements for patients and families who have non-LPCH contracted coverage.
• Informs corresponding Authorization Assistant Manager of any possible deferrals / denials of elective / non-emergent service requests that have not been approved prior to service date.
• Communicate with access nurse and/or appropriate clinician for necessary triage and/or to help resolve any insurance issues.

Education

High school diploma or GED

Job description

Lucile Packard Children’s Hospital Stanford, part of Stanford Children’s Health, seeks an Authorization Coordinator to manage day-to-day financial clearance for scheduled services and serve as a resource on complex authorization issues. You will ensure high-quality customer service in line with hospital PCARES practices and policies.

The role reports to the Authorization Assistant Manager and requires collaboration with multiple departments to secure referrals and approvals while minimizing