LPN Authorization Coordinator

POSITION SUMMARY

C ommunicat es 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. Document s authorization numbers, concurrent denial s , attempts to overturn denials . C oordinat ion of concurrent denial appeals between ph ysicians and insurance providers. Collaborates with Patient Access, Case manager, UR n urse 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 ap propriate a nd 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

Please indicate whether you have ever been convicted of a crime, including any misdemeanors and/or DUI/DWI. (Criminal conviction(s) will not automatically exclude you from consideration for employment).