Authorization Coordinator

Where compassion meets innovation and technology and our employees are family.

GENERAL PURPOSE OF JOB:

Using the EPIC EMR system, individual will be responsible for working with surgical staff and patients family to schedule surgeries. Verifies insurance hospital coverage for all patients and obtains authorizations needed for all surgeries for both inpatient and outpatient benefits. Individual also will have to ensure all surgical clearances needed prior to surgery including cardiac, neurological and pulmonology are obtained. Will act’s as primary liaison between Driscoll Children’s Hospital’s operating room, physicians and/or their designees regarding the scheduling of all surgical procedures. Ensures fair and even administration of the rules regarding the scheduling of elective surgical procedures. Also works as liaison between families hospital financial coordinator when families do not have insurance for patients who urgently need surgery.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as assigned by the immediate supervisor and/or hospital administration as required.

• Maintains utmost level of confidentiality at all times.
• Adheres to hospital policies and procedures.
• Calls insurance companies for pre-certifications requirements.
• Obtains prior authorizations for both in-patient and out-patient services for all patient cases.
• Ensures that patients that require surgical clearances are obtain prior to the scheduled surgery.
• Ensure that all medications that need prior authorization are done and ready for the patients surgery
• Coordinates and works with DME companies for wound care vac’s which require authorization.
• Ensure that home health is coordinated prior to patient discharge.
• For kidney transplant patients, it is necessary to ensure that all labs and ancillary services are coordinated for a successful surgery.
• Coordinates schedules with outside vendors that support the physicians including ENT and Urology for any surgeries that require such services.
• Coordinates surgeries with other surgeons including Plastic, Neurology and Pulmonology for patients that require multiple services.
• Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.
• Inputs appropriate data necessary for proper and accurate scheduling of elective surgical procedures.
• Ensures thorough schedule management that optimizes utilization of elective surgical time and surgical equipment.
• Maintains and updates the EPIC surgical scheduling system .
• Troubleshoots problems with scheduling system and identifies / implements corrective actions.
• Obtains consent signatures of parents/guardians for hospital surgical consents.
• Communicates with OR Manager, Operations Coordinator, and Director of Surgical Services for problem resolution or to provide information of pending issues.
• Provides admitting physicians and/or consultants with appropriate patient information and insurance benefits
• Adheres to current scheduling policies and procedures and ensures even and fair application of policies and procedures for all physicians utilizing DCH’s operating room.
• Uses appropriate communication and interpersonal skills to facilitate problem resolution.
• Assist families coordinate their over nights stays with lodging at the Ronald McDonald House, transportation and immigrations letters to travel for their child’s surgery.
• Is available 24/7 to physicians via cell phone to answer any questions related to surgical service scheduling.
• Reschedule surgeries when child is sick and surgery needs to be post-ponded
• Performs other duties as needed and assigned.

EDUCATION AND/OR EXPERIENCE:

• High school diploma or general education degree (GED); and two to three years related experience and/or training in medical field; or equivalent combination of education and experience.
• Experience with ICD 10 and CPT coding
• Strong knowledge of clinical/medical practice operations, procedures, terminology, and administrative procedures