Authorization Coordinator

The Authorization Coordinator is responsible for managing referrals and authorizations for TPIRC’s patient population. This role works directly with patients, insurance companies, financial counselors, scheduling, business office, and clinical departments to execute all aspects of the referral and authorization process efficiently and accurately. This individual is responsible for resolving authorization inquiries, updating the EMR/PM system(s), and communicating outcomes to other stakeholders within TPIRC. The Authorization Coordinator will demonstrate knowledge in all areas of the medical billing process and will serve as the referral and authorization expert for the organization.

Duties and Responsibilities:

Eligibility and Benefits Verification:
Perform eligibility and benefits inquiries for both new and established patients prior to patient appointments.
Enter and make the appropriate changes in the EMR/PM system(s) and Salesforce regarding insurance eligibility and benefits coverage.
Determine and maintain/update copayment, coinsurance, deductible, and out-of-pocket amounts.
Respond to and resolve eligibility and benefit verification tickets via Salesforce.
Respond to email and phone calls related to eligibility and benefits verification.
Verify eligibility and benefits using a real-time system response, through health plan portals, and/or via telephone to the health plan and/or guarantor.
Responsible for verifying COB information and communicating with the health plan and/or guarantor.
Proficient with turnaround time compliance in all aspects of the eligibility and benefits verification process
Provides patient education of services and benefits.

Authorizations:

• Responsible for reviewing upcoming patient appointments to secure pre-certification, authorization, and/or referral prior to the patient appointment and/or medication as needed.
• Gather and complete the required documents to request referral/authorization from the health plan.
• Submit supporting documentation as needed to health plans or referring providers.
• Ensure and document appropriate follow-up.
• Responsible for creating authorization orders, submissions, and working the requests using the Authorization Tracker via the EMR system.
• Process referral/authorization requests through the health plan portal, via email, and/or via telephone to the health plan and/or guarantor.
• Proficient with turnaround time compliance in all aspects of the prior authorization process.
• Enter and make the appropriate changes in the EMR/PM system(s) and Salesforce regarding referral/authorization status.
• Submit request for continuity of care
• Document instructions for the clinical team in the EMR/PM system(s) and Salesforce.
• Respond to and resolve referral and authorization tickets via Salesforce.
• Respond to emails and phone calls related to referral and authorizations.
• Performs job duties with oversight.
• Other duties as assigned.

General:

• Collaborate with patients or customers, third party institutions and other team members to research and resolve billing inconsistencies and errors.
• Collect and maintain patient demographic and medical information required for medical billing.
• Ensure patient documentation is scanned and filed correctly within the Electronic Medical Record (EMR).
• Provide exceptional customer service.
• Maintain and understand various medical billing software platforms.
• Navigate insurance websites and answers customer inquiries.
• Understand office visit fees including procedure and diagnosis codes.
• Maintain confidentiality and adhere to HIPAA regulations.
• Complete assigned tickets as required.
• Adhere to policies and procedures, update of forms and manuals.
• Assist in development and communication of SOP for key areas to improve accuracy and understanding of processes.
• Support daily, weekly, and monthly medical billing metrics.
• Identify issues and present possible solutions and/or suggestions to management.
• Interfaces with other departments to resolve medical billing workflows.
• Assist other staff and support the team approach.
• Communicate appropriately and clearly to management, co-workers, and physicians.
• Maintain all reference material that is provided by the supervisor, manager, or director.
• Know and follow the Employee Handbook policies and procedures.
• Maintain patient confidentiality so that HIPAA compliance is observed at all times.
• Demonstrate honesty and integrity in everyday activities.
• Arrive to work on time.
• Consistently be at work.

Qualifications:

• High School diploma or equivalent required
• Customer Service experience required
• 3 years of experience in medical billing required
• 3 years of experience in a specialty group practice
• Comfortable navigating across various computer systems to locate critical information.
• Medical billing and coding certification preferred.
• Knowledge of insurance policies/guidelines, EOB (Explanation of Benefits), prior authorization/referral processes, medical terminology, CPT/ICD/HCPCS coding preferred.
• Experience with payor portals and affiliates.
• Experience with EMR and PM systems (Athena, AdvancedMD a plus)
• Experience using Salesforce a plus
• Must have strong analytical skills, proficient with spreadsheets
• Knowledge of health networks, IPA, HMO, PPO and contract affiliations.
• Exceptional organizational, presentation, and communication skills, both verbal and written.
• Proficiency in meeting deadlines and prioritize workload.
• Ability to work independently, with direction, and as part of a team.
• Experience with Microsoft Office Suite
• Self-motivated, team-oriented, very responsible, and focused on exceeding customer expectations.

Working Conditions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand; walk; use hands to finger, handle or feel; and reach with hands and arms. The employee is required to walk between multiple office locations that include the use of stairs (elevator is only available in some instances).
This position requires the ability to occasionally lift office products and supplies, up to 20 pounds.

Physical Requirements:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
While performing the duties of this job, the employee is regularly required to talk or hear. The employee will be required to sit for long periods of time. The employee frequently is required to stand; walk; use hands to finger, handle or feel; and reach with hands and arms. The employee is required to walk between multiple office locations that include the use of stairs (elevator is only available in some instances).
This position requires the ability to occasionally lift office products and supplies, up to 20 pounds.

The Translational Pulmonary and Immunology Research Center (TPIRC) provides equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, marital status, veteran status, or any other consideration made unlawful by federal, state, or local laws.

TPIRC is committed to providing reasonable accommodation for qualified applicants, and employees with disabilities to ensure they enjoy equal access to all employment opportunities and benefits of employment as required by the Americans with Disabilities Act. TPIRC is an Equal Opportunity Employer and participant in the U.S. Federal E-Verify program.

Please note that TPIRC has adopted a mandatory COVID-19 vaccination policy for all employees. We believe this approach to be most effective in ensuring the continued safety of our team and our patients, and congruent with the local and national guidance provided to workers within the healthcare industry.

Should you choose to join the organization, you will be required to submit appropriate documentation within the first 45 days of employment. TPIRC will make reasonable accommodations due to disability or religious reasons, as required by law. Temporary deferrals may also be requested (i.e. pregnancy or recent COVID-19 illness).