Patient Authorization Coordinator

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  • San Leandro, CA
  • Finance
  • Authorization Services
  • Full Time - Day
  • Req #: 25030-16395
  • Posted: January 7, 2020
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Summary

JOB SUMMARY: The Patient Authorization Coordinator is accountable for processing authorizations, benefits verification, pre- registration, communication to providers, payers and patients, appeals, and coordination with Utilization Review and Referral Management team. This position is responsible for performing core utilization management functions in a timely manner. Provides key essential administrative support to ensure pre- registration and support utilization management operations are smooth and timely. The Patient Authorization department ensures that Alameda Health System receive timely authorization for services rendered at AHS for their patient population. Performs related duties as  required.

DUTIES & ESSENTIAL JOB FUNCTIONS: NOTE: The following are the duties performed by employees in
this classification.  However, employees may perform other related duties at an equivalent level.  Not
all duties listed are necessarily performed by each individual in the classification.

1.  Accountable for timely follow up and navigating through the Alameda Health System to respond to any stakeholders’ inquiry.  Assists with reporting and analysis for departmental outcomes.

2.  Assists Physician Advisors and Medical Directors with benefit interpretation, review payer based guidelines for medical necessity and research clinical issues.

3.  Collaborates and communicates regularly with AHS and non AHS physician offices, patients, contracted Health Plans, Medical/Provider Groups, ancillary vendors, industry wide organizations (i.e. Department of Managed Health Care, Alameda County Health department, California Children’s Services), internal departments and any other providers when appropriate.

4.  Informs and advises medical providers of patients’ financial status and maintains open communication with Physicians and clinical staff to ensure timely notification of any health conditions or diagnosis that could qualify patient for programs to assist them with their healthcare costs.

5.  Processes and files appeals with Health plans or Medical/Provider Groups as directed by the referring provider.  Generates required correspondence/review notification to patients and providers of authorization determination or any barriers leading to scheduled services such as self-pay, continuity of care, and cancellation of schedule.

6.  Advises patient/guarantor of financial obligations and collects and processes deposits, co-payments and pre-payments for services.

7.  Responsible for accurate and timely authorization submissions as outlined by AHS contractual arrangements with payers.  Responsible for accurately entering data for authorizations and other data elements.  Researches clinical guidelines from different sources and obtains clinical notes from providers for review.

8.  Responsible for all incoming and outbound requests, questions, concerns, and complaints in a timely, respectful, caring, and competent manner.

MINIMUM QUALIFICATIONS:

Education: High school diploma, Associate’s or Bachelor’s degree preferred.

Minimum Experience: Two or more years of experience in a managed care or medical practice setting; experience in processing and reviewing authorizations, working with providers in a practice or managed care setting; ability to multitask, communicate effectively.

Preferred Licenses/Certification: Certified Professional Coder (CPC) or completion of an accredited Medical Assistant program.

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