This is a work from home/remote role. Must be located in the Nashville, TN market.
Last year our HCA Healthcare colleagues invested over 156,000 hours volunteering in our communities. As a Division Admissions Coordinator with TriStar Health you can be a part of an organization that is devoted to giving back!
Job Summary and Qualifications
The Central Authorization Coordinator is responsible for managing/coordinating all day-to-day managed care admissions with the Post Acute Transition Specialists and/or admissions staff with all managed care payers. This includes utilizing an interdisciplinary approach to coordinate the insurance approval of care of all necessary types of post-acute disposition patients to assure smooth, efficient functioning Post Acute Service Units and delivery of quality health care services.
The Central Authorization Coordinator acts as the business and clinical resource for the department. Utilizes quality improvement activities and audits as necessary, development of new programs and clinical procedures, and collaboration with Division Post Acute Service Units to promote efficiency and customer service and assists Market Managers and Program Directors as necessary. Assists AVP with coordination and management of central authorization program. Assumes additional supervisory/administrative responsibilities as assigned by AVP.
What you will do in this role:
- Perform pre-certifications, insurance verifications and is responsible for the data integrity with regard to referral tracking
- Coordinate final admission approvals that come through communications with the Medical Director, Post Acute Transition Specialists and Program Director.
- Gather and collect pertinent clinical information to aid in the insurance approval process.
- Cultivate positive relationships with and maintain an environment of collaboration and cooperation at all levels of the organization, including the Medical and clinical staff, referral sources and community partners.
- Positively and professionally represent the unit with internal and external customers, other shareholders, and the public.
- Meet position requirements and performs essential functions.
- Provide timely, accurate, and complete reports as requested.
- Communicate effectively and appropriately when handling calls.
- Respond within established time frames to request for in-patient insurance approval.
- Accurately assess patient condition, status, needs and medical record data for cost/benefit analysis and medical determination for program admissions.
- Complete admission assessment forms in complete and legible manner to include all authorization numbers, days approved, and when updates are due.
- Accurately apply primary and secondary medical diagnostic information to support
- presentation of assessment/admission the insurance provider and all other necessary parties.
- Assure payment sources are current, accurate and available.
- Provide pertinent clinical information to non-Medicare payors, for initial pre-certification of rehab stay in a timely manner.
- Communicate/collaborate effectively and timely with Post Acute Transition Specialists, Program Director and/or Medical Director as needed, relaying non-Medicare insurance information, to allow for timely approval and admission.
- Enter all pertinent information in hospital computer system documenting information accurately and completely.
- Ensure information related to the patient’s benefits and resources is accurately documented in hospital computer system.
- Demonstrate knowledge to appropriately communicate to Post Acute Transition Specialists and/or Case Manager; the patient’s financial responsibility and requirements for insurance benefits.
- Coordinate payment negotiations as dictated by Business Office Manager, Market Manager/Program Director and/or Finance Department.
- Maintain knowledge of the objectives of the company and implication for programs, policies, and decisions.
- Knowledge of methods and procedures for the analysis, interpretation, and display of information.
- Ability to identify and resolve causes of business, staff, and customer problems using quality improvement principles.
- Ability to analyze and interpret numerical/statistical information to draw conclusions.
- Ability to identify and implement cost-reduction opportunities.
- Develop and communicate a shared vision for department(s) consistent with the goals and objectives of the Division.
- Develop strategic plan/goals to support departmental progress and achievement of hospital goals.
- Ability to set priorities when faced with conflicting alternatives and varying conditions.
- Ability to plan and conduct multiple activities within a specified time frame in order to ensure goal/deadline achievement.
- Identify role as a team member and works efficiently to achieve goals of team, department, and hospital.
- Demonstrate professional behavior in actions and consistently portray a positive attitude.
- Respect diversity of each individual (e.g. patients, families, physicians, and co-workers).
- Manage conflict effectively and/or seeks appropriate assistance from manager or HR to resolve conflict.
- Demonstrate consistent use of customer service skills (acknowledging others, phone skills, anticipating, and responding to customer needs).
- Participate in division/hospital/departmental performance/quality improvement activities.
- Assist with establishing written standards/procedures and department specific policies.
What qualifications you will need:
- Current LVN, LPN, RN, PT, OT, or SLP license preferred.
- BLS (AHA) certification required.
- High School Diploma or equivalent education required; graduate of an accredited school of nursing or accredited education per licensure requirements preferred.
- 1 year of experience working with Managed Care insurance plans with firsthand knowledge/experience in approval/authorization process in post-acute care services required.
- Strong interpersonal and program development skills required.
Benefits
TriStar Health offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:
- Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services
- Wellbeing support, including free counseling and referral services
- Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence
- Savings and retirement resources, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling
- Education support through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing
- Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts
Learn more about Employee Benefits
Note: Eligibility for benefits may vary by location.
HCA Healthcare has been named one of the World’s Most Ethical Companies by Ethisphere Institute for ten consecutive years (2010-2019). In 2019, HCA Healthcare spent an estimated 3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.
"There is so much good to do in the world and so many different ways to do it."- Dr. Thomas Frist, Sr.
HCA Healthcare Co-Founder
Be a part of an organization that invests in you! We are reviewing applications for our Central Authorization Coordinator opening. Qualified candidates will be contacted for interviews. Submit your application and help us raise the bar in patient care!
We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.
