What are the responsibilities and job description for the Authorization Coordinator Utilization Review Per Diem Days position at Placentia-Linda Hospital?
Job Details
Since 1972, Placentia-Linda Hospital has expanded right along with north Orange County. As our communities grow, we continue to offer a full range of medical services to meet your family’s needs. One thing remains the same — our caring and compassionate staff, which is committed to providing excellent quality and customer satisfaction. The numerous awards and distinctions we’ve earned demonstrate that. The Joint Commission, the leading accreditor of healthcare organizations in America, once again named Placentia-Linda Top Performer on Key Quality Measures in 2014. The hospital was recognized for exemplary performance in using evidence-based clinical processes that are shown to improve care for certain conditions.
We offer competitive salaries and benefits including a matching 401(k), several health & dental plans to choose from, generous tuition assistance plans, and relocation assistance for select positions.
The individual in this position works under the direction of the Utilization Review RN and reports to the Director of Case Management. The individual responsibilities include but not limited to the following actions:
Request / Confirm Authorization for admission and days Document authorization number and days in CM system. Follow up on patient accounts for when authorization for stay is required. Fax numbers to send clinical reviews
Enter denial / dispute/ no authorization in CM system
Document incoming and outgoing payer communications
Follow up on each account during the stay and on discharge for authorization - document authorization in the electronic system,
Escalate any potential disputes or denial of accounts to director of Case Management or designee
Trends disputed claims by at least payer and physician
Assist in obtaining authorization for patient discharged to Skilled Facilities or other post- acute care that require authorization
Trend by payer and service any authorization not obtained by end of day
Trend and Track on denial prevention
Send for secondary evaluation of care review and P2P when required
Maintains accurate address book in All scripts
Maintains accurate contact list for IPA Case Managers
Attend Surgery tempo rounds, and update surgery patient’s authorizations
Qualifications:
QUALIFICATIONS
Required- High School Diploma or equivalent
Preferred- Associate or Bachelor Degree
EXPERIENCE REQUIRED
Acute Hospital Experience, Health insurance experience, demonstrated knowledge of medical terminology.
SKILLS REQUIRED
Excellent organizational skills, excellent verbal and written communication skills, demonstrated problem solving skills, proficient in Microsoft Office including Word and Excel spreadsheets.
#LI-JT4
Tenet complies with federal, state, and/or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date. If you receive an exemption from the vaccination requirement, you will be required to submit to regular testing in accordance with the law.
JOB: Non-Clinical/Administrative
PRIMARY LOCATION: Placentia, California
FACILITY: Placentia-Linda Hospital
JOB TYPE: PT2Y
SHIFT TYPE: Days
Employment practices will not be influenced or affected by an applicant’s or employee’s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
Tenet participates in the E-Verify program.
Since 1972, Placentia-Linda Hospital has expanded right along with north Orange County. As our communities grow, we continue to offer a full range of medical services to meet your family’s needs. One thing remains the same — our caring and compassionate staff, which is committed to providing excellent quality and customer satisfaction. The numerous awards and distinctions we’ve earned demonstrate that. The Joint Commission, the leading accreditor of healthcare organizations in America, once again named Placentia-Linda Top Performer on Key Quality Measures in 2014. The hospital was recognized for exemplary performance in using evidence-based clinical processes that are shown to improve care for certain conditions.
We offer competitive salaries and benefits including a matching 401(k), several health & dental plans to choose from, generous tuition assistance plans, and relocation assistance for select positions.
The individual in this position works under the direction of the Utilization Review RN and reports to the Director of Case Management. The individual responsibilities include but not limited to the following actions:
Request / Confirm Authorization for admission and days Document authorization number and days in CM system. Follow up on patient accounts for when authorization for stay is required. Fax numbers to send clinical reviews
Enter denial / dispute/ no authorization in CM system
Document incoming and outgoing payer communications
Follow up on each account during the stay and on discharge for authorization - document authorization in the electronic system,
Escalate any potential disputes or denial of accounts to director of Case Management or designee
Trends disputed claims by at least payer and physician
Assist in obtaining authorization for patient discharged to Skilled Facilities or other post- acute care that require authorization
Trend by payer and service any authorization not obtained by end of day
Trend and Track on denial prevention
Send for secondary evaluation of care review and P2P when required
Maintains accurate address book in All scripts
Maintains accurate contact list for IPA Case Managers
Attend Surgery tempo rounds, and update surgery patient’s authorizations
Qualifications:
QUALIFICATIONS
Required- High School Diploma or equivalent
Preferred- Associate or Bachelor Degree
EXPERIENCE REQUIRED
Acute Hospital Experience, Health insurance experience, demonstrated knowledge of medical terminology.
SKILLS REQUIRED
Excellent organizational skills, excellent verbal and written communication skills, demonstrated problem solving skills, proficient in Microsoft Office including Word and Excel spreadsheets.
#LI-JT4
Tenet complies with federal, state, and/or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date. If you receive an exemption from the vaccination requirement, you will be required to submit to regular testing in accordance with the law.
JOB: Non-Clinical/Administrative
PRIMARY LOCATION: Placentia, California
FACILITY: Placentia-Linda Hospital
JOB TYPE: PT2Y
SHIFT TYPE: Days
Employment practices will not be influenced or affected by an applicant’s or employee’s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
Tenet participates in the E-Verify program.
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