Job description
Santa Ana, CA
RESPONSIBILITIES AND DUTIES:
Ensure timely verification and validation of authorizations for all Commercial and Managed care inpatients and other services as assigned.- Contacts insurance companies via phone or website to secure authorization.
- Responsible to review all discharged managed care patients for evidence of authorization entry in the Authorization module.
- Obtains missing authorizations within 3 business days of patient’s discharge or in some cases within 7 days of admission.
- Responsible for checking bill hold weekly for pending authorizations.
- Assists with sending delinquent reviews and resending reviews not received by the Payors.
- Communicate effectively, build and maintain professional, cooperative relationships with Case Management and all departments that have direct or indirect impact on obtaining authorizations.
- Maintains analysis of authorization issues, by payer.
- Reports monthly summary for authorization issues to senior leadership.
- Clearly documents all contacts and authorization information for all types of authorizations in the hospital system, complete standardized documentation requirements in expected format.
- Follows established hospital policies and procedures regarding authorization processes.
- Other duties as assigned.
The posted pay scale represents the range the Company reasonably expects to pay candidates for this position. The actual wage for this position may depend on factors such as experience and education, specific skills and abilities, alignment with similar internal candidates, marketplace factors, an applicable collective bargaining agreement, and Company business practices.
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