Pre-Authorization Coordinator

The PAVE Coordinator is responsible for initiating Pre-Authorization request to the payer for the claims that require approval. This position require communication with payers, patients, physician offices and hospital clinical staff. This position is primarily responsible for pre-certifying procedures ordered by physicians. The PAVE Coordinator will also be responsible monitoring appropriateness and medical necessity and provides necessary information for authorization and continued visits. This individual will confirm pre-certifications that have been obtained or will obtain pre-certifications if needed in addition to conducting quality assurance.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

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;

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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 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

Benefit packages for this role will start on the 1st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.