2 Authorization Coordinator Jobs in Philadelphia, PA
CareRing Health is Hiring an Authorization Coordinator Near Philadelphia, PA
We are seeking talented, passionate individuals to join our team and help our patients live happier and healthier lives…in their homes.
What We Offer*:
We Know That, To Be The Best Place For Our Patients, We Must Be The Best Place To Work For Our Employees. We Offer The Following To Our Employees
- Be part of a unique healthcare company where we can help those in our communities who need our help the most
- Flexible hours/work-life balance (full-time or part-time available)
- Competitive pay
- Paid on a weekly basis
- Medical/dental/vision/life insurance
- Paid holidays/PTO/401(k) match
- Career growth opportunities
- Great and collaborative work environment
Under the supervision of the Director of Clinical Services , the Medical Management Licensed Practical Nurse (LPN) is responsible for Prior Authorization, Concurrent and Post Service authorization requests and provides additional support to the registered nurses in performing clinical review of prior authorizations submitted for the list of procedures designated on the Medical Prior Authorization List. The Medical Management LPN will work within Immediate Home Health & Hospice requirements for completion and turn-around times for requests and assists with adherence to established processes.
Responsibilities Include But Are Not Limited To
- Perform data entry and case review of prior authorization request submitted to the Medical Management department.
- Gathers clinical documentation for cases preparation. Assists in the medical review process of authorization requests and claims review as appropriate to assist in making medical necessity decisions and benefit determinations.
- Follows Immediate Home Health & Hospice medical policies in making determinations regarding coverage for health care services. Makes approval determinations according to written protocols and guidelines as appropriate.
- Communicates with members and providers regarding benefit issues and keeps up to date on health plans and
- Communicates with registered nurses or medical directors if questions arise re: policy whenever necessary.
- Maintains documentation of decision-making regarding each case.
- Maintains knowledge of the Medical Prior Authorization List and applicable Medical Policy and member certificate information.
- Works closely with other nursing staff to discuss cases and for making determinations.
- Communicates with clinic and other requesting facility staff and practitioners to obtain additional information for case documentation.
- Maintains proficiency in use of computer access to obtain medical information needed.
- Attends weekly Pre-Case Review and Case Review Meetings.
- Assists with writing and sending of non-authorization letters.
- Maintains proficiency and ongoing knowledge of CPT and ICD coding. Complies with appropriate accreditation
- Takes accurate and complete telephone messages and refers calls to RN as necessary.
- Identifies and refers potential quality of care issues to RN Case Manager for follow-up.
- Attends and actively participates in Medical Management Meetings.
- Participates in Medical Management activities and attends departmental in-services as scheduled.
- Assists with second review of claims.
- Performs initial aspects of researching medical policy information for yearly updates as needed.
- Performs HEDIS chart reviews, quality of care reviews and medical policy research as needed and provides proper documentation of findings.
- Participates in internal quality reviews to support continuous quality improvement initiatives within the department.
- Supports Quality Care Coordinators with programs as necessary.
- Adhere & Uphold Immediate Home Care & Hospice Mission, Vision and Values and Health Service & Performance Standards
- Other duties as assigned.
- Active LPN state license (preferred)
- Certificate from Practical Nurse Program
- 3 Years working in medical setting
- Experience working with health insurance
- Eligibility for certain benefits may depend on employment status
Job Summary
Full Time
$58k-72k (estimate)
07/03/2024
07/31/2024
The job skills required for Authorization Coordinator include Patient Care, Data Entry, Initiative, etc. Having related job skills and expertise will give you an advantage when applying to be an Authorization Coordinator. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Authorization Coordinator. Select any job title you are interested in and start to search job requirements.
The following is the career advancement route for Authorization Coordinator positions, which can be used as a reference in future career path planning. As an Authorization Coordinator, it can be promoted into senior positions as a Patient Referral Specialist that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Authorization Coordinator. You can explore the career advancement for an Authorization Coordinator below and select your interested title to get hiring information.
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