Authorization Coordinator

Authorization CoordinatorThe 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 ResponsibilitiesSubmit 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 daysReview 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 ncourage others' successNew ideas; anticipate problemsPick 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 clientsInteract 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 monthsAuthorizations are submitted within 48 hours of notification; based on a monthly averageAuthorization approvals should not exceed a monthly average of 5 business daysObtain 90% approval rating from client satisfaction surveys obtained.Ownership towards a solutionWhen a problem is presented to the team or to management it should be accompanied by at least one feasible solution.Reach Life BalanceEmbody a positive approachCommunication 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.RequirementsHigh School Diploma or equivalentMinimum 1 year experience with prior authorization servicesOncology experience is a plusWorking knowledge of oncology specific codes and payer rules for commercial, Medicare, Medicare Advantage, and Medicaid plans preferred.Knowledge of ICD10, CPT, and HCPCS codes and rules for Tech/Pro/Global and Freestanding/HOPPS coding preferred.Physical Demands and Work Environment: The physical demands described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the functions.Ability to lift/carry up to 25 pounds.Ability to sit/stand for long periods of time.Good manual dexterity with the ability to perform repetitive hand/wrist motions.Requires mastery of complex language, comprehension, reasoning, and analytical skills typically found in mid to high-level work.Typical office environmentWorks onsite at client location. May require travel at times to RBS office locations.Moderate noise levelsDisclaimer: This job description in no way states or implies that these are the only duties to be performed by the employee(s) of this position. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by any person authorized to give instructions or assignments. All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities.The company is an equal opportunity employer, drug-free workplace, and complies with ADA regulations as applicable.