Treatment Authorization Request Coordinator - Full Time, Day Shift

Adventist Health Northwest Heart Center; Glendale (CA); On-site; USD 42,000 - 64,000; Full time

Job summary

Adventist Health Glendale is seeking a credentialing/authorization specialist to obtain insurance coverage and authorizations for uninsured patients. You will collaborate with government agencies, attorneys, physicians, and other medical professionals to monitor progress and improve denial rates.

The role emphasizes reviewing accounts for necessary authorizations, documenting in the EHR, and escalating disputes to management as needed.

Qualifications

• Preferred: High School Education/GED or equivalent.
• Preferred: Associate’s/Technical Degree or equivalent.
• Preferred: Five years of related experience.

Responsibilities

• Follows up on patient accounts when authorization for care or treatment is required. Faxes and sends clinical reviews.
• Follows up on each account during the stay and on discharge for authorization. Documents information in electronic health record system.
• Escalates any potential disputes or denial of accounts to management.
• Reviews trends of disputed claims by payor and/or physician, etc. Assists in obtaining authorization for patient discharged.
• Performs other job-related duties as assigned.

Skills

Insurance verification

Authorization management

Data analysis

Education

High School/GED or equivalent (Preferred)

Associate’s/Technical Degree or equivalent (Preferred)

Five years’ related experience (Preferred)

Job description

Nestled between Burbank and Pasadena, Adventist Health Glendale is one of the area's leading healthcare providers. We are comprised of a 515-bed hospital, two urgent cares, home care services, comprehensive cardiology care and a vast scope of services located in the San Fernando Valley. We are committed to the development and empowerment of our nurses and have received Magnet designation from the American Nurses Credentialing Center. Glendale is known for its urban living, with easy access to dining, entertainment, shopping, amusement parks and outdoor recreation. Adventist Health Glendale is proud to be part of the thriving, diverse community since 1905.

Job Summary:

Obtains insurance coverage and authorizations for uninsured patients. Works with various government agencies, attorneys, physicians and other medical professionals as needed. Analyzes and tracks databases and patients to monitor progress and improve denial rates.

Job Requirements:

Education and Work Experience:

• High School Education/GED or equivalent: Preferred
• Associate’s/Technical Degree or equivalent combination of education/related experience: Preferred
• Five years' related experience: Preferred

Essential Functions:

• Follows up on patient accounts when authorization for care or treatment is required. Faxes and sends clinical reviews.
• Follows up on each account during the stay and on discharge for authorization. Documents information in electronic health record system.
• Escalates any potential disputes or denial of accounts to management.
• Reviews trends of disputed claims by payor and/or physician, etc. Assists in obtaining authorization for patient discharged.
• Performs other job-related duties as assigned.

Organizational Requirements:

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.
Adventist Health participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.