Prior Authorization Coordinator
Eskenazi Health

Division:Eskenazi Health

Sub-Division:Hospital

Req ID:21915

Schedule:Full Time

Shift:Days

Eskenazi Health serves as the public hospital division of the Health & Hospital Corporation of Marion County. Physicians provide a comprehensive range of primary and specialty care services at the 333-bed hospital and outpatient facilities both on and off of the Eskenazi Health downtown campus including at a network of Eskenazi Health Center sites located throughout Indianapolis.

FLSA Status

Non-Exempt

Job Role Summary

The Prior Authorization Coordinator utilizes a database of prior authorization and utilization data to obtain prior approvals for services provided by the organization. This position participates in the development and maintenance of databases specifying the precise prior authorization requirement for each client we serve.

Essential Functions and Responsibilities

• Utilizes a database of prior authorization and utilization data to obtain prior approvals for services provided by the organization
• Develops an intricate knowledge of the specific characteristics of each insurance plan and their contact personnel to assist in job function
• Submits prior authorization requests through telephone contact, form completion and fax communication with third party payers and their representatives
• Participates in the development and maintenance of databases specifying the precise prior authorization requirement for each client we serve
• Submits the prior authorization request for each client assigned who requires a prior authorization
• Communicates the outcome of the prior approval activity on a routine basis to the organization's administration and to the clinical areas
• Participates in the development and maintenance of a system of tracking and managing denials of claims. Communicates this information on a routine basis to administration staff and to the clinical areas
• Determines client insurance eligibility through web-based applications
• Communicates data with clinical staff to ensure that services are provided within the parameters of the Prior Authorization and/or additional prior authorization requests are completed as needed
• Compiles data to trend identified issues with Prior Authorization for process improvement
• Enters prior authorization data in to appropriate systems
• Participates as a member of the team assigned to manage the billing and claim affairs of the organization. Alerts this team and the supervisor of issues that arise in the course of this data development
• Assists those staff assigned to claim payment functions to facilitate the efficient payment of claims
• Performance Improvement-focused to facilitate the development of progressively more sophisticated and efficient prior authorization, billing and claims processes
• Designs custom reports and documentation utilizing appropriate software applications
• Develops advanced computer skills to facilitate the development of databases, spreadsheets, and the utilization of other web-based applications
• Reviews new bulletins and other sources of information and informs management of any updates or changes
• In response to the changing nature of reimbursement in our industry, assists management in developing procedures for change
• Communicates effectively with internal and external contacts

Job Requirements

• High school diploma or equivalent (GED)
• Bachelor's degree preferred
• Minimum of 1 year of experience in a health care setting
• Minimum of 2 years of experience with prior authorizations, billing or related field

Knowledge, Skills & Abilities

• Proficient in utilizing Microsoft Office, i.e. Excel, Word, and PowerPoint
• Ability to learn software applications quickly
• Excellent verbal and written communication skills
• Positive interpersonal skills
• Excellent organizational skills
• Extensive knowledge of Medicaid and Medicare billing and regulations
• Must be goal oriented, capable of completing task within a given time frame, including overcoming any barriers that arise
• Able to troubleshoot barriers and resolve within a reasonable amount of time
• Self-starter with strong problem solving skills
• Ability to work independently and as part of a team
Meets the following competencies:
• Production / Accuracy
• System / Software Applications

Accredited by The Joint Commission and named as one of Indiana's best employers by Forbes magazine for two consecutive years and the top hospital in the state for community benefit by the Lown Institute, Eskenazi Health's programs have received national recognition while also offering new health care opportunities to the local community. As the sponsoring hospital for Indianapolis Emergency Medical Services, the city's primary EMS provider, Eskenazi Health is also home to the first adult Level I trauma center in Indiana, the only verified adult burn center in Indiana and Sandra Eskenazi Mental Health Center, the first community mental health center in Indiana, just to name a few.

Nearest Major Market: Indianapolis