Luminis Health · 20 hours ago
Preauthorization Coordinator
Annapolis, MD
Full-time
Onsite
Entry Level
$17.50/hr - $26/hr
2+ years expLuminis Health is a healthcare organization, and they are seeking a Preauthorization Coordinator. The PAVE Coordinator is responsible for initiating pre-authorization requests for claims, communicating with various stakeholders, and ensuring proper authorization is in place for patient services.
Health CareMedicalNon Profit
Responsibilities
Serve as primary resource for LH regarding insurance eligibility; prior authorization process and requirements; collects patient demographic information and coverage information
Advises patients of their financial obligation and collects payments in a courteous and professional manner
Contacts insurance companies by phone, fax, or online portal to obtain insurance benefits, eligibility, and authorization information
Updates systems with accurate information obtained; performs quality assurance audits and reports back to leadership opportunities for providing education to patient access
Responsible for communicating to service line partners of situations where rescheduling is necessary, due to lack of authorization or limited benefits and is approved by clinical personnel
Ensures that proper authorization is in place for inpatient, elective, outpatient, surgical, urgent/emergent services and held responsible for timely notification to payers of the patient’s visit to the facility to protect financial standing of the organization
Escalates non-authorized accounts/visits to management
Ensures all benefits (Copays, Deductibles, Co-Insurance, OOP, LTM), authorizations, pre-certifications, and financial obligations of patients, are documented on account, clearly, accurately, precise, and detailed to ensure expeditious processing of patient accounts and denial prevention
Maintains a close working relationship with clinical partners, and ancillary departments to ensure continual open communication between clinical, ancillary, and Patient Access & Patient Financial Services, Surgical Scheduling departments. Case Management, and Utilization Review to facilitate the sending of clinical information in support of the authorization to the payer, as assigned
Monitors team mailbox, e-mail inbox, faxes, and phone calls responding to all related PAVE account issues, within defined time frames; Adheres to the department accuracy and performance standards
Contact payer to obtain prior authorization. Gather additional clinical and or coding information, as necessary, in order to obtain prior authorization
Provide standardized documentation within system to identify prior authorization and the criteria surrounding such authorization; Verify that all insurance requirements have been met; Notify patient, Provider’s Office, Scheduling and Financial Counselor immediately when insurance coverage is inadequate or has been terminated
Advises providers and their clinical staff when issues arise relating to obtaining prior authorization; educate providers and their clinical staff regarding the prior authorization process
Stay informed and research information regarding insurance criteria for prior authorization; Attend department staff meetings, professional education sessions, complete e-learnings and mandatory training
Performs other duties as assigned by PAVE Leadership
Qualification
Required
Minimum two (2+) years of experience in Medical Billing, Hospital Patient Access, or Hospital Business Office in an automated setting
Knowledge of registration, verification, pre-certification, and scheduling procedures
Experience with Medical and Insurance terminology (ICD-10, CPT 4)
Minimum of one (1+) year of demonstrated strong analytical skills
Proficiency with Microsoft Office and Outlook
Excellent verbal and written communication skills
Preferred
Preferred experience with the Epic Hospital Billing System
Associates Degree Accounting, Finance, Business Administration or Healthcare related field preferred
Minimum two (2+) years of Revenue Cycle Experience in lieu of degree
1 or more Certifications preferred: CRCE - Certified Revenue Cycle Executive, CRCP- Certified Revenue Cycle Professional, CRCS- Certified Revenue Cycle Specialist, CHAM – Certified Healthcare Access Manager, CHAA- Certified Healthcare Access Associate, CHFP- Certified Healthcare Financial Professional, CRCR- Certified Revenue Cycle Representative
Benefits
Medical, Dental, and Vision Insurance
Retirement Plan (with employer match for employees who work more than 1000 hours in a calendar year)
Paid Time Off
Tuition Assistance Benefits
Employee Referral Bonus Program
Paid Holidays, Disability, and Life/AD&D for full-time employees
Wellness Programs
Employee Assistance Programs and more*Benefit offerings based on employment status
Company
Luminis Health
Luminis Health is a not for profit organization that provides exceptional health care services.
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
Amy Beales
Chief Human Resources Officer
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