POSITION SUMMARY

Communicates with payors to obtain authorization for all patients as required and pending post-acute placement. Provide clinical information to payors as required under the direction of UR nurse. Documents authorization numbers, concurrent denials, attempts to overturn denials. Coordination of concurrent denial appeals between physicians and insurance providers. Collaborates with Patient Access, Case manager, UR nurse and physicians to facilitate obtaining authorizations. Timely escalates any potential disputes or denials to Director of Case Management or UR nurse.

DUTIES AND RESPONSIBILITIES

Validates daily that all Managed care/Commercial cases have an appropriate authorization and notify DCM or UR nurse of variances Document authorization and denial information in Care Management documentation system Submits initial clinical information within 24 hours of admission as directed by UR nurse Concurrently make sure all clinical needed by payors or updates provided by alerting UR nurse and/or DCM Coordinate Peer-to-Peer arrangements between physicians and insurance providers on denials when appropriate and document outcome Maintains confidentiality of patient/physician/personnel information/hospital proprietary information Performs other duties as assigned Maintains licensure/certification, BLS, etc. as required

EDUCATION AND EXPERIENCE

Experience with Microsoft Office, Word, Excel, and Outlook required Experience with EMR strongly preferred Manages time effectively, sets priorities, and consistently meets deadlines Excellent communication skills, both written and oral required Demonstrates initiative and pro-active approach to problem resolution Demonstrates good organizational skills and attention to detail Ability to work independently with little supervision Louisiana licensed LPN required 2 to 4 years' healthcare experience preferred