Manage the Authorization process end to end, from initial notification, entry and submission of required information, follow up all the way to determination and discharge.
Maintain detailed documentation of the record in the EMR system, in the internal CorroHealth system and in the Health Payer portals.
Verify correct eligibility and benefits for patients.
Act as a liaison between the hospital staff and the Health Payer to facilitate information sharing and successful process completion within allocated timeframe.
Review timely filing guidelines regarding the utilization management process.
Track and follow up with payers on pending authorizations to ensure timely responses.
Contact payer to elicit further information regarding status, decisions and remove hurdles in the processing.
Identify and escalate issues that may result in delays or denials.
Manage assigned workload of accounts through timely follow up and accurate record keeping.
Maintain compliance with HIPAA and other healthcare regulations.

High School Diploma or equivalent.
Associate degree in healthcare administration or equivalent preferred.
2 years of experience in hospital related billing/follow-up/healthcare setting/authorization field.
Knowledge of/experience working with managed care contracts
Experience working with customer support/client issue resolution management.
Strong understanding of medical terminology and insurance processes.
Experience working in EMR systems, Epic preferred.
Excellent communication and organization skills.
Strong multi-tasking skills, working in a face paced environment.
Proficiency with MS Office and web systems.

Coordinator, Utilization Management

Key skills