Vaco
Central Authorization Coordinator
The Central Authorization Coordinator is responsible for coordinating and processing new and extended cases within the department's workflow. This role ensures accurate verification of insurance, patient demographic setup, billing information, and submission of insurance authorizations in compliance with third-party payer requirements and regulatory guidelines.
Key Responsibilities
Authorization Verification and Management (60%)
Receive and process Medicare Part B referrals via the designated central authorization system.
Verify and accurately interpret patient benefits through online portals, providing timely communication of benefits to referring facilities.
Follow up on submitted authorizations to ensure approvals are obtained within an acceptable timeframe.
Submit and track re-authorization requests, maintaining accurate records in the Central Authorization Tracking Log.
Communicate any payer-related or location-specific issues to management as they arise.
Provide electronic copies of insurance verifications and patient responsibility details to relevant stakeholders.
Ensure timely authorization submissions for services upon receipt of evaluation documentation.
Appeal Tracking and Administration (20%) Prepare and send medical record appeal packets in collaboration with therapy vendors, clinical directors, and administrative staff. Maintain accurate appeal tracking data, updating logs with submission statuses and adjustments. Review retrospective post-payment medical record reviews, ensuring takeback adjustments are processed within required timeframes. Communicate appeal updates to relevant team members, ensuring transparency and coordination.
Data Entry and System Management (20%) Validate and enter patient demographic and billing details for accuracy and completeness. Complete all authorization-related workflow tasks to maintain data integrity. Ensure proper statement setup before month-end close. Enter authorization numbers into billing systems in a timely and accurate manner. Track outpatient care episodes within the electronic medical records system. Assist with therapy billing code entry as needed.
Additional Duties Perform other tasks and responsibilities as assigned.
Qualifications Education: High school diploma or equivalent required.
Experience: Experience in insurance, billing, or central intake roles involving insurance authorization required. Preferred experience in long-term care, hospital, or healthcare accounting settings. Familiarity with Medicare Advantage and Medicaid eligibility preferred. Proficiency in Windows, Microsoft Office (Word, Excel, PowerPoint), and internet-based applications required.
Other Requirements: Must be able to read, write, speak, and understand English fluently.
Appeal Tracking and Administration (20%) Prepare and send medical record appeal packets in collaboration with therapy vendors, clinical directors, and administrative staff. Maintain accurate appeal tracking data, updating logs with submission statuses and adjustments. Review retrospective post-payment medical record reviews, ensuring takeback adjustments are processed within required timeframes. Communicate appeal updates to relevant team members, ensuring transparency and coordination.
Data Entry and System Management (20%) Validate and enter patient demographic and billing details for accuracy and completeness. Complete all authorization-related workflow tasks to maintain data integrity. Ensure proper statement setup before month-end close. Enter authorization numbers into billing systems in a timely and accurate manner. Track outpatient care episodes within the electronic medical records system. Assist with therapy billing code entry as needed.
Additional Duties Perform other tasks and responsibilities as assigned.
Qualifications Education: High school diploma or equivalent required.
Experience: Experience in insurance, billing, or central intake roles involving insurance authorization required. Preferred experience in long-term care, hospital, or healthcare accounting settings. Familiarity with Medicare Advantage and Medicaid eligibility preferred. Proficiency in Windows, Microsoft Office (Word, Excel, PowerPoint), and internet-based applications required.
Other Requirements: Must be able to read, write, speak, and understand English fluently.