Authorization Coordinator - Arcadia OHNS Clinic - Full Time 8 Hour Days (Non-Exempt) (Non-Union)

The Authorization Coordinator coordinates communication with admitting, case management, patient financial services, and payers to ensure all inpatient services provided by the hospital are authorized by appropriate payer. He/She will facilitate the timely transmission of concurrent and discharge reviews to the appropriate payer and ensures that authorized days are obtained and documented.

To coordinate communication with the physician, clinic staff, admitting, case management, physician CBO, patient financial services, and payers to ensure all inpatient services provided by the hospital are authorized by appropriate payer. To ensure that authorized days are obtained and documented.

Essential Duties:

• Collaborates with admitting personnel to ensure all insurance contacts are identified and documented in CMS within 2 working days of admission.
• Reviews daily census to identify all insurance patients.
• Reviews authorization log in CMS to ensure authorizations are current.
• Accesses EIQ reports as needed to track admission and concurrent InterQual reviews.
• Monitors the timely completion of clinical reviews by the Case Managers.
• Reviews all insurance cases upon discharge to ensure clinical reviews have been completed and sent to the appropriate payer.
• Coordinates retrospective reviews by receiving review requests, gathering and dissemination documentation as necessary. Enters data in a timely manner, ensuring that all data is accurate.
• Inputs authorization data into spreadsheets to generate reports for analysis.
• Builds and maintains good working relationships with all payer staff, physicians, and IPA/Medical Groups.
• Maintains communication with payers and appropriate IPA/outside case manager.
• Assists with denial management to identify opportunities to improve department processes.
• Maintains awareness of payer/reimbursement practices/requirements.
• Responds to insurance requests for clinical reviews.
• Assists with orientation of new personnel regarding payer communication.
• Identifies opportunities to improve department workflow and process regarding payer communication.
• Collaborates with admissions case manager regarding appropriate patient status and communication with payer.
• Facilitates TAR process to ensure TAR’s are completed and submitted within three working days of patient’s discharge.
• Documents communication with payers and outcomes of discussions in CMS system and FUS notes.
• Elevates issues impending timely authorization retrieval or scheduling to Director immediately.
• Adheres to hospital policies, procedures, and standards.
• Provides afternoon phone coverage for the department.
• Other duties as assigned by department Director.

Required Qualifications:

• Req High school or equivalent

• Req Experience with computer data entry and spreadsheets.
• Req Prior experience in a healthcare setting (ie hospital, physician office, managed care)

• Req Good verbal and written communication skills.
• Req Demonstrate excellent customer service behavior.
• Req Medical terminology knowledge.
• Req Ability to be self directed and work with minimal supervision.
• Req Ability to work collaboratively with multiple personnel and prioritize multiple tasks.

Preferred Qualifications:

Required Licenses/Certifications:

• Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire, and maintained by renewal before expiration date. (Required within LA City only)

The hourly rate range for this position is $25.00 - $39.69. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.

Salary : $25 - $40