Prior Authorization Coord
Company: Lifespan Corporation
Posted on: January 11, 2022
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
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
Collaborates with various Lifespan 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
Regularly participates in business team meetings with staff and
management to make recommendations where there are perceived
Performs other duties as assigned.
High school diploma or equivalent required. Knowledge of business
systems office procedures computer skills medical terminology and
health insurance processes/terminology including but not limited to
CPT and ICD-10 coding.
Strong organizational skills critical thinking and focus to detail
required to manage high volume of radiologic orders requiring prior
authorization and/or financial clearance.
Analytical skills to evaluate effectiveness of work flow with the
ability to make recommendations develop and adapt to changes as
Interpersonal skills necessary to provide effective communication
with patients and other healthcare professionals within and outside
Two years of previous experience in health care environment with
emphasis in health insurance billing and reimbursement healthcare
operations database management and patient/ provider
WORK ENVIRONMENT AND PHYSICAL REQUIREMENTS:
Normal office environment; may experience some visual fatigue as
result of extended periods of work on the computer.
Performs independently within the departments policies and
practices. Refers specific complex problems to the supervisor when
clarification of the departmental policies and procedures are
Lifespan is an Equal Opportunity / Affirmative Action 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. Lifespan
is a VEVRAA Federal Contractor.
Location: The Miriam Hospital USA:RI:Providence
Work Type: Full Time
Shift: Shift 1
Keywords: Lifespan Corporation, Providence , Prior Authorization Coord, Other , Providence, Rhode Island
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