Do you want to join an organization that invests in you as a(an) Insurance Authorization Coordinator? At Work from Home, you come first. HCA Healthcare has committed up to $300 million in programs to support our incredible team members over the course of three years.
Job Summary and Qualifications
The Central Authorization Coordinator manages and coordinates daily managed care admissions for post-acute patients, utilizing an interdisciplinary approach to secure insurance approval for various post-acute dispositions (e.g., Inpatient Rehabilitation, Home Health, Hospice, LTACH, SNF). This role acts as a business and clinical resource, driving efficiency, quality improvement, and customer service within Post Acute Service Units, and supports the central authorization program under Market Director. The coordinator is responsible for continuous evaluation and engagement with insurance payers to ensure efficient and appropriate authorization for medically referred patients, adhering to HCA and Nursing Professional Standards.
Major Duties:
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- Manage and coordinate daily managed care admissions for post-acute patients.
- Coordinate insurance approval for various post-acute care services.
- Serve as a business and clinical resource for the department.
- Implement quality improvement activities and develop new programs/procedures.
- Collaborate with Division Post Acute Service Units to enhance efficiency and customer service.
- Assist Market Director with advancement of the central authorization program.
- Continuously evaluate and engage with insurance payers for patient authorization.
- Maintain accurate and current patient records.
- Contribute to educational programs and uphold hospital standards of conduct.
- Perform pre-certifications, insurance verifications, and ensure data integrity for referral tracking.
- Gather and collect pertinent clinical information to aid in the insurance approval process.
- Cultivate positive relationships and maintain collaboration with medical/clinical staff, referral sources, and community partners.
- Positively and professionally represent the unit with internal and external customers.
- Provide timely, accurate, and complete reports as requested.
- Communicate effectively and appropriately when handling calls.
- Respond within established time frames to requests 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 legibly, including authorization numbers, approved days, and update due dates.
- Accurately apply primary and secondary medical diagnostic information to support assessment/admission presentation to insurance providers.
- 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 Clinical Rehabilitation Specialists, Market Director, Program Director, facility staff, and/or Medical Director regarding pre-certification status.
- Enter all pertinent information accurately and completely into the hospital computer system.
- Ensure patient benefits and resources information is accurately documented in the hospital computer system.
- Communicate patient financial responsibility and insurance benefit requirements to Clinical Rehabilitation Specialists and/or Case Managers.
- Coordinate payment negotiations as directed by Business Office Manager, Market Manager/Program Director, and/or Finance Department.
- Identify role as a team member and work efficiently to achieve goals.
- Demonstrate professional behavior and consistently portray a positive attitude.
- Respect diversity of individuals (patients, families, physicians, co-workers).
- Manage conflict effectively or seek appropriate assistance.
- Demonstrate consistent use of customer service skills.
- Participate in performance/quality improvement activities.
- Assist with establishing written standards/procedures and department specific policies.
- Accept additional responsibilities and assist in other areas to provide good customer service.
- Arrange daily schedule for efficient use of time, equipment, and personnel.
- Participate in the efficiency and quality of department operation and growth.
- Effectively prioritize work to proceed in an orderly and organized manner.
- Ensure proper use/care of equipment.
- Attend in-services/meetings to improve education and training.
- Seek opportunities to improve processes and collaborate with others. |
What qualifications you will need:
- Minimum 1 year experience working with Managed Care insurance plans with first-hand knowledge/experience in approval/authorization process in post acute care services.
- Required: High School or College- Bachelor degree
-Preferred: Current LVN, LPN, RN, PT, OT, SLP License.
-Preferred: BLS (AHA) Certification.
Benefits
Work from Home, 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 (Corporate), based in Nashville, Tennessee, supports a variety of corporate roles from business operations to administrative positions. Like our colleagues in any HCA Healthcare hospital, our corporate campus employees enjoy unparalleled resources and opportunities to reach their potential as healthcare leaders and innovators. From market rate compensation to continuing education and career advancement opportunities, every person has a solid foundation for success. Nashville is also home to our Executive Development Program, where exceptional employees are groomed to take on CNO- and COO-level roles in our hospitals. This selective program focuses on ethics, leadership and the financial and clinical knowledge required of professionals at this level of the industry.
HCA Healthcare has been recognized as one of the World’s Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.
"Good people beget good people."- Dr. Thomas Frist, Sr.
HCA Healthcare Co-Founder
We are a family 270,000 dedicated professionals! Our Talent Acquisition team is reviewing applications for our Insurance Authorization Coordinator opening. Qualified candidates will be contacted for interviews. Submit your resume today to join our community of caring!
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.
