Description

AIM OF THE POSITION

The Patient Access Coordinator is responsible for requesting authorization for all applicable incoming orders. This process includes understanding of payers’ medical policies for our services, collecting and reviewing all the necessary documentation required to submit prior authorization, contacting the ordering physician or their office for additional information if applicable, completing the required authorization submission forms within allotted timeframes and, follow-up with the payor to obtain an authorization determination. When applicable, the PA Coordinator will also submit a Prior Authorization appeal if criteria is met but the PA was denied erroneously. 

POSITION WITHIN THE ORGANIZATION

1. Customer Care, Sales, Commercial and external vendors

2. Cooperates with all departments across the organization

Requirements

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Reviews incoming orders to determine if authorization is required

• Reviews documentation from ordering physician for completeness to meet the medical policies of payors and work them in priority dependent on allotted timeframes per payer as the time can vary.

• Contacts ordering physician's office to obtain missing documentation when applicable or to meet timeliness of the submissions

• Communicate with physician offices and/or sales team for assistance with authorization submissions, when applicable

• Verifies diagnosis code on order in line with current ICD 10 requirements

• Completion of authorization forms via paper or online

• Submit authorizations to payors via fax, through payor portal, or third party vendor with all required documentation to maximize success in achieving approvals

• Log authorization actions within the billing system for tracking

• Follow up on all open authorization submissions including those submitted by the third party vendor

• Notify billing staff and document account when authorization determination is received

• Additional tasks as needed

The above listing represents the general duties considered essential functions of the job and is not to be considered a detailed description of all the work requirements that may be inherent in the position. 

KEY CONTACTS

• Internal: This position may interface with various departments within the company.

• External: Clients and Payors

EDUCATION AND EXPERIENCE REQUIREMENTS

EDUCATION

• High School diploma or general education degree

• 1 + years related experience preferable 

KNOWLEDGE, SKILLS AND ABILITIES (KSA’S) 

Specific Knowledge Required: 

Knowledge: Comprehension of a body of information acquired by experience or study. 

Skill: A present, observable competence to perform a learned activity. 

Ability: Competence to perform an observable behavior. 

• Medical Pre-Authorization knowledge/experience 1 + years

• Knowledge of CPT and ICD 10 codes

• Previous medical billing experience preferred

• Ability to read and understand medical payer policies as well as pathology reports

• Ability to work with sensitive and confidential information

· PRIVACY NOTICE:  To review the California privacy notice, click here:  https://agendia.com/privacy-policy/ 

· Employees must not be classified as an excluded individual who is prohibited from participation in any Federal health care program.

BEHAVIOURAL COMPETENCIES/DESIRED SKILLS

• Must be able to work in a fast-paced environment 

• Must have strong organizational skills and attention to detail 

• High degree of accuracy 

• Manage Multiple tasks independently 

• Excellent problem resolution 

• Excellent customer service skills 

• "Outside the Box" thinker 

• Other Skills necessary: Analytical thinking, thoroughness, good research skills, and strong verbal/written communication.

WORKING ENVIRONMENT

Establishes ADA (Americans with Disabilities Act) requirements

ENVIRONMENT/SAFETY/WORK CONDITIONS

• General office environment. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Maintains a clean, neat, and orderly work area.

• Adheres to Department Specific Safety Guidelines.

• Standing, sitting, walking, bending, reaching, manual manipulation, and lifting up to 15 pounds.

TRAVEL

No travel is required.

OTHER DUTIES

Other duties as required by management