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LMC Authorization Coordinator

Company: Valley Medical Center
Location: Renton
Posted on: May 3, 2021

Job Description:

Job Description

Lifestyle Medicine

The position description is a guide to the critical duties and essential functions of the job, not an all-inclusive list of responsibilities, qualifications, physical demands and work environment conditions. Position descriptions are reviewed and revised to meet the changing needs of the organization.

TITLE: LMC Authorization Coordinator

ROLE: The position is responsible for Lifestyle Medicine treatment authorization with a great deal of independence but under the direction and guidance of the Manager. Works closely with Insurance Verifiers, Admitting Registrars, Providers, Insurance Companies and Patients.

HOURS: Typically, Monday - Friday, 8:00 am to 5:00 pm or as needed to meet departmental needs.

AREA OF ASSIGNMENT: Lifestyle Medicine and Wellness

RESPONSIBLE TO: Lifestyle Medicine Supervisor, Manager or Director

PREREQUISITES:

  • High School Graduate or equivalent (G.E.D.) required.

  • Minimum 3 years of experience in medical and/or insurance industry.

  • Knowledge of medical terminology and abbreviations; can spell and understand commonly used terms preferred.

  • Basic skills in keyboarding and using a personal computer in Windows and Microsoft applications required.

  • Prior experience in using practice management and electronic medical record systems.

QUALIFICATIONS:

  • Demonstrated knowledge of clinical ICD-10, CPT, and HCPCS.

  • Professional written and verbal communication skills using the English language.

  • Ability to problem solve, exhibit independent decision-making skills.

  • Demonstrated ability to function independently and manage time.

  • Demonstrated ability to access, analyze and apply concepts associated with protocol, policy and guidelines.

  • Ability to recognize and understand clinical documentation pertinent for obtaining prior authorizations

  • Neat and well-groomed appearance, business professional.

  • Demonstrated ability to successfully utilize varying computer tools and software packages:

a. Utilize multiple monitors in facilitation of workflow management

c. Healthcare websites/Provider portals

d. Business practice management system

TYPICAL PHYSICAL/MENTAL DEMANDS, ENVIRONMENT AND WORKING CONDITIONS: Requires legible and writing and computer/keyboard skills. Excellent telephone skills are essential. Regular and punctual attendance is a condition of employment. Requires the ability to maintain self-composure and a positive attitude under stress. Requires flexible scheduling and extended hours as needed. Requires problem solving and coaching ability and effective resolution of conflicts.

PERFORMANCE RESPONSIBILITIES:

  • Generic Job Functions: See Generic Job Description for Administrative Partner.

  • Essential Responsibilities and Competencies:

  • Clear knowledge of Current Procedural Terminology (CPT), International Classification of Diseases (ICD), and Healthcare Common Procedure Coding System (HCPCS) coding system.

  • Excellent analytical and critical thinking skills and a focus for detail is needed.

  • Strong organizational skills to effectively plan, direct and manage high volume of treatments requiring prior authorization.

  • Interpersonal skills; works as part of an integrated team comprised of Patient Access, Insurance Verifiers, Patient Financial Services, Lifestyle Medicine providers and Admitting Registrars.

  • Contacts insurance companies to obtain prior authorization for treatment; including physical and occupational therapy, massage therapy, nutrition and diabetes education and integrated Lifestyle Medicine Programs.

  • Coordinates referrals to lifestyle medicine services and collaborates with Admitting Registrars on scheduling.

  • Has functional knowledge of patient access and billing operations in the specialized field of Lifestyle Medicine.

  • Organizes, pre-authorizes and distributes pre-authorizations in a timely manner to all interested parties.

  • Acts as a resource to Patients with referral and authorization questions.

  • Processes incoming referrals and ongoing patient accounts to ensure proper insurance authorization is obtained and maintained.

  • Coordinates benefits for incoming patients and explores payment options so that our accounts are financially secure.

  • Provides price quotes, payment options and authorization.

  • Resolves insurance denials and coordinates with billing to ensure proper coding and documentation is performed.

  • Communication with patients regarding insurance benefits, authorization and billing process.

  • Requires collaboration with Director, clinical providers and fitness staff to ensure safe, efficient, professional and patient-centered care is provided.

  • Position is independently directed with high attention to detail.

  • Demonstrates clear knowledge of the clinic structure, standards, procedures and guidelines

  • Maintains department specific records as assigned, update and verifies patient data in EMR.

  • Routinely reviews insurance policy updates/change to stay abreast of new ICD-10 and HCPCS pre-authorization requirements.

  • Comfortable with continual change and can assimilate new information and use it as needed in daily operations.

  • Informs manager of pre-authorization requirement changes, potential barriers; maintains open line of communication to facilitate additional changes. Understands and follows formal chain-of-command guidelines in performing job duties.

  • Projects and/or other assigned duties.

Created: 10/17

Grade: NCNM21

FLSA: E

CC: 7305

Job Qualifications:

PREREQUISITES:

  • High School Graduate or equivalent (G.E.D.) required.

  • Minimum 3 years of experience in medical and/or insurance industry.

  • Knowledge of medical terminology and abbreviations; can spell and understand commonly used terms preferred.

  • Basic skills in keyboarding and using a personal computer in Windows and Microsoft applications required.

  • Prior experience in using practice management and electronic medical record systems.

QUALIFICATIONS:

  • Demonstrated knowledge of clinical ICD-10, CPT, and HCPCS.

  • Professional written and verbal communication skills using the English language.

  • Ability to problem solve, exhibit independent decision-making skills.

  • Demonstrated ability to function independently and manage time.

  • Demonstrated ability to access, analyze and apply concepts associated with protocol, policy and guidelines.

  • Ability to recognize and understand clinical documentation pertinent for obtaining prior authorizations

  • Neat and well-groomed appearance, business professional.

  • Demonstrated ability to successfully utilize varying computer tools and software packages:

a. Utilize multiple monitors in facilitation of workflow management

c. Healthcare websites/Provider portals

d. Business practice management system

Keywords: Valley Medical Center, Renton , LMC Authorization Coordinator, Other , Renton, Washington

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