Remote
R1

Authorization Coordinator

Insurance Services AUTHO03719

  • Full-Time
  • Remote USA
  • United States

Job Details

Description

Shift: Monday- Friday, Hours will vary.

R1 is a leading provider of technology-enabled revenue cycle management services which transform and solve challenges across health systems, hospitals and physician practices. Headquartered in Chicago, R1 is publicly-traded organization with employees throughout the US and international locations.

Our mission is to be the one trusted partner to manage revenue, so providers and patients can focus on what matters most. Our priority is to always do what is best for our clients, patient’s and each other. With our proven and scalable operating model, we complement a healthcare organization’s infrastructure, quickly driving sustainable improvements to net patient revenue and cash flows while reducing operating costs and enhancing the patient experience.

The Authorization Coordinator will be responsible for creating required insurance authorizations on behalf of the responsible physician’s office for scheduled patients. Direct patient contact may be required to secure patient’s information such as demographics and insurance information, which is needed to determine patient’s eligibility, coverage, and authorization requirements. Authorization Coordinators will understand payer requirements and have the ability to read and understand clinical information to support the patients need for care. Success in this role is measured with the use of weekly productivity scorecards.

Responsibilities:

  • Initiates contact with client hospital patients via telephone using appropriate scripting to ensure the patient’s medical record is current with details such as demographics and insurance information, as needed.
  • Initiates contact with insurance companies via website, fax, or telephone using appropriate scripting to ensure the required level of benefit and pre-certification/authorization requirements are obtained.
  • Communicates with other departments as needed for order accuracy and completion.
  • Utilizes hospital EMR systems to obtain clinical information.
  • Creates timely insurance authorizations on behalf of the responsible physician office.
  • Effectively coordinates Peer to Peer discussions between Clinicians and Insurance companies.
  • Provides superior customer service to all patients, works through patient-raised issues, and recommends appropriate solutions.
  • Maintains organized, detailed summaries of prior authorization requests to support post-claim denial workflows.
  • Complete appropriate electronic forms with detailed benefit and authorization information to ensure a clean claim.
  • Identifies inaccurate plan codes and corrects in the hospital’s main frame.
  • Adheres to the guidelines set forth in the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI).

Required Qualifications:

  • High School diploma or equivalent
  • At least one (1) year of experience in authorization field
  • Excellent customer service skills exhibiting good oral and written communication skills
  • Ability to type fast and accurately
  • Must be able to communicate effectively and professionally to our patients and physician offices
  • Working knowledge of medical terminology, abbreviations and anatomy
  • Advanced knowledge of Health Insurance guidelines
  • Basic Microsoft Word and Excel
  • Ability to multitask and prioritize
  • Must be self-motivated

Desired Qualifications:

  • Coding/Billing experience

Working in an evolving healthcare setting, we use our shared expertise to deliver innovative solutions. Our fast-growing team has opportunities to learn and grow through rewarding interactions, collaboration and the freedom to explore professional interests.

Our associates are given valuable opportunities to contribute, to innovate and create meaningful work that makes an impact in the communities we serve around the world. We also offer a culture of excellence that drives customer success and improves patient care. We believe in giving back to the community and offer a competitive benefits package. To learn more, visit: r1rcm.com.