Authorization Verification Coordinator

General Summary:

Under general supervision, responsible for processing the patient, insurance and financial clearance aspects for both scheduled and non-scheduled appointments, including, validation of insurance and benefits, routine and complex pre-certification, prior authorizations, and scheduling/pre-registration. Responsible for triaging routine financial clearance work.

Principal Responsibilities and Tasks

The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. These are not to be construed as an exhaustive list of all job duties performed by personnel so classified.

1. Processes administrative and financial components of financial clearance including, validation of insurance/benefits, medical necessity validation, routine and complex pre-certification, prior-authorization, scheduling/pre-registration, patient benefit and cost estimates, as well as pre-collection of out of pocket cost share and financial assistance referrals.

2. Initiates and tracks referrals, insurance verification and authorizations for all encounters.

3. Utilizes third party payer websites, real-time eligibility tools, and telephone to retrieve coverage eligibility, authorization requirements and benefit information, including copays and deductibles.

4. Works directly with physician’s office staff to obtain clinical data needed to acquire authorization from carrier.

5. Inputs information online or calls carrier to submit request for authorization; provides clinical back up for test and documents approval or pending status.

6. Identifies issues and problems with referral/insurance verification processes; analyzes current processes and recommends solutions and improvements.

7. Reviews and follows up on pending authorization requests.

8. Coordinates and schedules services with providers and clinics.

9. Researches delays in service and discrepancies of orders.

10. Assists management with denial issues by providing supporting data.

11. Pre-registers patients to obtain demographic and insurance information for registration, insurance verification, authorization, referrals and bill processing.

12. Develops and maintains a working rapport with inter-departmental personnel including ancillary departments, physician offices, and financial services.

13. Assists Medicare patients with the Lifetime Reserve process where applicable.

14. Reviews previous day admissions to ensure payer notification upon observation or admission.

15. Must be willing to travel between facilities as needed (applies to specific UMMS Facilities).

16. Performs other duties as assigned.

University of Maryland Upper Chesapeake Health (UM UCH) offers the residents of northeastern Maryland an unparalleled combination of clinical expertise, leading-edge technology, and an exceptional patient experience.
A community-based, integrated, non-profit health system, our vision is to become the preferred, integrated health system creating the healthiest community in Maryland. We are dedicated to maintaining and improving the health of the people in our community through an integrated health delivery system that provides high quality care to all. Our commitment to service excellence is evident through a broad range of health care services, technologies and facilities. We work collaboratively with our community and other health organizations to serve as a resource for health promotion and education.

Today, UM UCH is the leading health care system and second largest private employer in Harford County. Our 3,500 team members and over 650 medical staff physicians serve residents of Harford County, eastern Baltimore County, and western Cecil County.

University of Maryland Upper Chesapeake Health owns and operates:
University of Maryland Harford Memorial Hospital (UM HMH), Havre de Grace, MD
University of Maryland Upper Chesapeake Medical Center (UM UCMC), Bel Air, MD
The Upper Chesapeake Health Foundation, Bel Air, MD
The Patricia D. and M. Scot Kaufman Cancer Center, Bel Air, MD
The Senator Bob Hooper House, Forest Hill, MD

Education and Experience

1. High School Diploma or equivalent is required.

2. Minimum 2 years of experience in healthcare revenue cycle, medical office, hospital, patient access or related experience.

3. Experience in healthcare registration, scheduling, insurance referral and authorization processes preferred.

Knowledge, Skills and Abilities

1. Knowledge of medical and insurance terminology.

2. Knowledge of medical insurance plans, especially manage care plans.

3. Ability to understand, interpret, evaluate, and resolve basic customer service issues.

4. Excellent verbal communication, telephone etiquette, interviewing, and interpersonal skills to interact with peers, superiors, patients, and members of the healthcare team and external agencies.

5. Intermediate analytical skills to resolve problems and provide patient and referring physicians with information and assistance with financial clearance issues.

6. Basic working knowledge of UB04 and Explanation of Benefits (EOB).

7. Some knowledge of medical terminology and CPT/ICD-10 coding.

8. Demonstrate dependability, critical thinking, and creativity and problem-solving abilities.

9. Knowledge of registration and admitting services, general hospital administrative practices, operational principles, The Joint Commission, federal, state, and legal statutes preferred.

10. Knowledge of the Patient Access and hospital billing operations of Epic preferred.

All your information will be kept confidential according to EEO guidelines.

 Compensation

• Pay Range: $18-$28.24
• Other Compensation (if applicable):
• Review the 2024-2025 UMMS Benefits Guide