AUTHORIZATION COORDINATOR - Patient Access - Per Diem - Days

Authorizations Coordinator - Per Diem

Shift: 8:00am - 12:00pm 

Job Description:

PATIENT POPULATION:
The patient population served can be all patients, including geriatric, adult, adolescent, pediatric, and newborn. This also includes services which affect facility staff, physicians, visitors, vendors and the general public.

POSITION SUMMARY:
Under the direction of the department Leader(s), the Outpatient Authorization Coordinator is responsible for the coordination and acquisition of authorizations.

Must be able to work normal/scheduled working hours to include Holidays, call-backs, weeknights, weekends, and on-call. Agrees to participate, as directed, in emergencies and community disasters during scheduled and unscheduled hours. As a designated disaster service worker you are required to assist in times of need pursuant to the California Emergency Services Act.
(Gov’t. Code §§ 3100, 3102)

Needs to recognize that they have an affirmative duty and responsibility for reporting perceived misconduct, including actual or potential violations of laws, regulations, policies, procedures, or this organization’s standards/code of conduct.

The employee shall work well under pressure, meet multiple and sometimes competing deadlines; and the incumbent shall at all times demonstrate cooperative behavior with colleagues and supervisors.

EDUCATION/TRAINING/EXPERIENCE:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

To perform this job successfully, an individual should have substantial knowledge of medical terminology, principles of management, and policies and procedures relating to the authorization process for various third-party payer programs.

Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence if required. Demonstrates both written and verbal communication skills.

Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, and percentages if required.

Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations. Cope with stress, due to fast paced, heavy workload. Exercise independent judgment, common sense and initiative. Prioritize in a timely manner. Analyze goals and objectives of the hospital and the departments. Attention to detail a must.

To perform this job successfully, an individual should have basic computer skills."


LICENSURE/CERTIFICATIONS:
To perform this job successfully, an individual should have a high school diploma or equivalent.


Responsibilities and Essential Functions:
*Indicates Essential Function

1 * Ensures that the out-patient services authorization is obtained prior to providing services as appropriate and is in accordance with various third party payer contracts.
2 * Inputs all requests for services received via fax or phone into the system accurately for electronically generated authorization and tracking.
3 Notifies required parties within the appropriate timeframe for routine and urgent requests for services.
4 * Acts as a liaison with the area Physicians and their staff, verifying physicians orders are in compliance with Sierra View Medical Center documentation standards.
5 * Forwards Authorizations to appropriate department staff in terms of eligibility and other coverage, pricing, and benefit issues.
6 Assists with Patient Access functions and regularly attends meetings and training seminars.
7 * Scans, attaches, reviews, and effectively works with electronic images as part of the authorization process, including recording the required information from attachments into the authorization fields.
8* Reviews schedules daily and ensures appropriate insurance and authorization has been obtained and documented.
9* Documentation reflects compliance with established hospital policies and procedures.
10 Ensures patients and/or departments are contacted prior to appointments to inform them of treatment schedule changes if necessary and when appropriate.