The Authorization Coordinator will be responsible for effectively acquiring Radiation Oncology authorizations, working denied authorizations and submitting appeals as needed. The Authorization Coordinator must be able to handle multiple, simultaneous tasks effectively and efficiently and is expected to demonstrate ENCORE in all communications.
Essential Duties and Responsibilities
•Submit referral, precertification and/or authorization for radiation oncology services from schedules two weeks out and checking back for add ons within 72 hours of exam to positively impact DSO for 100% of patients that require authorization.
•Average time from precertification and/or authorization request notification and submission to approval should not exceed 5 business days
•Review client queues and schedules daily to identify patients requiring authorization per payer requirements.
•Review guidelines to confirm if no auth is required that exam meets medical necessity.
•Communicate with physician/clinical staff on authorization issues and/or pre-certification requirements by the patient's insurance carriers.
•Identify and address denied authorizations to include the appeal process and denial resolution.
•Notify Billing Departments of any special instructions, for example, Skilled Nursing Facility or Inpatients. Demonstrated by <3% error rate on voids and/or rebills for this reason.
•Document accurate authorization activity to reflect work performed in physician/hospital system, billing system, and other systems as needed for reporting and tracking.
•Create relationships at the payer level to assist with initial authorization approval, reduce the need for peer-to-peer, and guarantee the successful reversal of authorization denials.
•Participate in all required meetings with client/personnel, become one of the team.
•Review processes and provides suggestions for process improvements and efficiencies.
•Stay up to date on all CPT/HCPCS/ICD-10 code changes and all payer policy authorization requirements.
•Exhibit ENCORE values.
Other Expectations/Skills
•Self-motivated with the ability to problem solve.
•Customer service focused
•Reliable and extremely trustworthy.
•Ability to maintain confidential and meticulous records.
•Excellent verbal and written communication skills.
•Proficient in Microsoft Office Suite or related software.
•Exceptional organizational skills and attention to detail.
•Ability to learn various software applications
•Superior analytical and technical skills.
ENCORE Values
Encourage others’ success
New ideas; anticipate problems
-Pick up on problematic client trends quickly and address them efficiently, bringing in management as appropriate.
-Bring at least one idea for a process improvement to the team quarterly.
Create financial value for our clients
-Interact with client staff and team members to ensure eligibility and authorization requests are completed in a timely and efficient manner.
-Gold Standard: Achieving Authorization goals in the same month 4 out of 6 rolling months
-Authorizations are submitted within 48 hours of notification; based on a monthly average
-Authorization approvals should not exceed a monthly average of 5 business days
-Obtain 90% approval rating from client satisfaction surveys obtained.
Ownership towards a solution
-When a problem is presented to the team or to management it should be accompanied by at least one feasible solution.
Reach Life Balance
Embody a positive approach
-Communication with clients and other RBS divisions should show an “I can” approach.
-Actively engage in department meetings and group conversations with a positive and upbeat attitude.
