Prior Authorization Coord

Overview

Under supervision of the Business Manager is responsible for the integrity of the prior authorization processes for Adult Ambulatory Services. Coordinates and arranges for assigned internally generated orders to ensure patients have received financial clearance from insurance companies and troubleshoot as needed.

• Confirms patient eligibility with insurance carriers/third party payors and obtains pre-authorization requirements in accordance with established medical policies.
• Coordinates and ensures appropriate insurance authorizations are obtained and/or received in a timely manner.
• Reviews, recognizes and understands clinical documentation from patient records pertinent to obtaining prior authorization as necessary.
• Analyzes orders, authorizations and records for discrepancies that may affect insurance coverage and/or denial of claims.
• Notifies and coordinates with ordering physicians and providers when peer-to-peer discussions are required to obtain prior authorization of services being denied by patients’ insurance.
• When necessary, contacts agencies outside the hospital to obtain pertinent patient information and to coordinate clinic/treatment programs.
• Collaborates with various Brown University Health personnel to resolve billing issues, authorization denials and insurance denials/write-offs.
• Provides mature, quality customer service to patients, their families and/or their representatives.
• Ensures all patients are financially cleared by insurance/ third party payor prior to their scheduled appointments.
• As assigned, ensures staff is made aware of changes in hospital or third-party procedures; ensures appropriate training and adherence to approved policies and processes directly or through supervisory staff.
• Regularly participates in business team meetings with staff and management to make recommendations where there are perceived problems.
• Performs other duties as assigned.

• Education
  :
  High school diploma or equivalent required. Knowledge of business systems, office procedures, computer skills, medical terminology and health insurance processes/terminology including CPT and ICD-10 coding.
• Experience
  :
  Two years of previous experience in health care environment with emphasis in health insurance billing and reimbursement, healthcare operations, database management and patient/provider interaction.
• Skills
  :
  Strong organizational skills, critical thinking and attention to detail to manage high volume of radiologic orders requiring prior authorization and/or financial clearance; analytical skills to evaluate workflow and adapt to changes; interpersonal communication with patients and healthcare professionals.

Normal office environment; may experience some visual fatigue as a result of extended periods of work on the computer.

Performs independently within the department’s policies and practices. Refers specific complex problems to the supervisor when clarification of the departmental policies and procedures are required.

None.

Brown University Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, ethnicity, sexual orientation, ancestry, genetics, gender identity or expression, disability, protected veteran or marital status. Brown University Health is a VEVRAA Federal Contractor.

Location:

Rhode Island Hospital USA:

RI:

Providence

Work Type:
Part Time

Shift: Shift 1

Union:
Non-Union