Authorization Coordinator

JOB SUMMARY

This paragraph summarizes the general nature, level and purpose of the job.

Reporting to the Authorization Assistant Manager and/or Supervisor, the Authorization Coordinator is responsible for providing day-to-day financial clearance of scheduled services assigned to the Authorization department work ques), and serving as a resource for all departments on complex referral / authorization issues for problem resolution. The Authorization Coordinator advises on authorization related questions and is expected to serve as a role model throughout the organization as providing high-quality customer service in accordance with established Hospital PCARES practices and department specific regulations, policies and procedures.

ESSENTIAL FUNCTIONS

The essential functions listed are typical examples of work performed by positions in this job classification. They are not designed to contain or be interpreted as a comprehensive inventory of all duties, tasks, and responsibilities. Employees may also perform other duties as assigned.

Employees must abide by all Joint Commission Requirements including but not limited to sensitivity to cultural diversity, patient care, patient rights and ethical treatment, safety and security of physical environments, emergency management, teamwork, respect for others, participation in ongoing education and training, communication and adherence to safety and quality programs, sustaining compliance with National Patient Safety Goals, and licensure and health screenings.

Must perform all duties and responsibilities in accordance with the hospital's policies and procedures, including its Service Standards and its Code of Conduct.

* Act as a patient and family advocate between obtaining necessary information from providers and fulfilling payers' referral/authorization requirements.
* Collaborates with corresponding providers and staff members from service sites to promote the success of obtaining referrals and authorizations.
* Tracks and notes patient accounts on the authorization status, follow up and payer issues. Assists respective Authorization team members in prioritizing clinically urgent cases and secure authorizations in advance to minimize LPCH's potential financial risks.
* Processes and follows-up on authorizations that have denials, peer-to-peer or further medical justification requirements.
* Follows-up on and corrects authorizations that require further research, review, or resubmission.
* Ensures all authorization claims edits holding claims are cleared timely and effectively in accordance to department and organizational set metrics and authorization standards.
* Investigate, resolve and document insurance issues in a timely and efficient manner, and contact corresponding stakeholders (Authorization Management, medical staff, other clinical staff, ancillary departments and administration) as needed.
* Facilitates the coordination with contracting to obtain letters of agreements for patients and families who have non-LPCH contracted coverage.
* Informs corresponding Authorization Assistant Manager of any possible deferrals / denials of elective / non-emergent service requests that have not been approved prior to service date.
* Communicate with access nurse and/or appropriate clinician for necessary triage and/or to help resolve any insurance issues.