Prior Authorization Coordinator - Temporary

Agendia Inc.•Irvine, CA

About The Position

AIM OF THE POSITION The Prior Authorization 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 when applicable, completing the required authorization submission forms within allotted timeframes and, follow-up with the payor to obtain an authorization determination. When applicable, the Prior Authorization Coordinator will also submit a Prior Authorization appeal if criteria is met but the Prior Authorization was denied erroneously. POSITION WITHIN THE ORGANIZATION 1. Customer Care, Sales, Commercial and external vendors 2. Cooperates with all departments across the organization

Requirements

High School diploma or general education degree
1 + years related experience preferable
Medical Pre-Authorization knowledge/experience 1 + years
Knowledge of CPT and ICD 10 codes
Ability to read and understand medical payer policies as well as pathology reports
Ability to work with sensitive and confidential information
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.

Nice To Haves

Previous medical billing experience preferred

Responsibilities

Reviews incoming assigned orders to determine if authorization is required
Reviews documentation from ordering physician for completeness to meet the payor requirements.
When needed, contacts ordering physician's office to obtain missing documentation.
Communicate with physician offices and/or sales team for assistance with authorization submissions, when applicable
Verifies the diagnosis code provided by the billers to ensure that it is in line with current ICD 10 requirements
Completion of authorization through the proper avenue (i.e., Phone, Glidian, Payor Portal, Fax).
Document the Salesforce Billing Detail screen with the proper statuses and actions including Criteria Reason when applicable.
Upload all written authorization determinations either from the payor portal or received via Fax or US mail.
Follow up on all open authorization submissions.
Additional tasks as needed