Access Coordinator, Prior Authorization

Job Description

A Patient Access Prior Authorization Coordinator is responsible for independently managing all work related to medical necessity-based authorizations for all diagnostic imaging services , while also demonstrating a strong understanding of payer coverage policies, applying appropriate payer guidelines to all aspects of radiology prior authorization work. The coordinator will leverage their strong understanding of medical terminology and physiology to retrieve the appropriate clinical documents (e.g., progress notes, lab values, scan results) from within the electronic medical record (EMR). The Access Coordinator will create thorough, concise prior authorization requests to all payers.

In the Patient Access Department, we are committed to providing our employees with the ongoing education and professional development by offering;
  • A remote opportunity by working from home
  • A structured 4-tier career ladder for continued career advancement.
  • A work environment where your contributions and ideas are valued .


Responsibilities

  • Reviews and monitors all radiology authorization work queues and independently identifies and prioritizes imaging procedures with the greatest financial reimbursement risk.
  • Reprioritizes work to respond to clinically urgent diagnostic imaging procedures and produces high quality work under pressure.
  • Verifies insurance eligibility and benefits, utilizing automated eligibility systems, payer portals, or telephone communication.
  • Prepares and completes payer-specific prior authorization requests, interprets medical policy criteria, and applies appropriate guidelines to prior authorization requests.
  • Reviews and comprehends patient progress notes, lab reports, infusion summaries, imaging reports, and plan of care. Identifies appropriate medical documentation to satisfy payer medical policy criteria.
  • Responds to health plan-reviewed prior authorization requests that do not meet initial policy criteria. Works with the health plan to resolve issues and/or coordinates appropriate provider-to-health plan interventions (e.g., peer-to-peer discussions, letters of medical necessity, provider-initiated appeals, etc.).
  • Follows-up with patients in the case of denied coverage of a radiology exam. Provides superior customer service to all patients, works through patient-raised issues, and recommends appropriate solutions.
  • Interfaces with provider's offices and medical staff to ensure all necessary documentation is obtained for purposes of pursuing a successful authorization approval
  • Documents accurately into the Electronic Medical Record (EMR) system all actions, interactions, and authorizations surrounding the insurance process for each patient
  • This position has no supervision responsibilities
  • Duties, responsibilities, and activities may change at any time with or without notice
  • Other duties may be assigned as needed by supervision


Qualifications

  • Minimum Required: 1 - 2 Years equivalent experience completing Registration, Scheduling, Pre-certifications/prior authorizations in a hospital setting, medical office setting, Patient Access or similar environment.
  • Preferred: 3 - 5 Years equivalent experience completing Registration, Scheduling, Pre-certifications/prior authorizations in a hospital setting, medical office setting, Patient Access or similar environment.