Medical Insurance Coordinator

Location: Steward Medical Group - North

Posted Date: 12/2/2021

This position will be a key member of the Department of Otolaryngology and SMG (Steward Medical Group) for prior authorizations and referrals, and pre-surgical insurance authorizations. The employee will be responsible for obtaining prior authorizations/referrals for High Tech Radiology Studies (CT, MRI, Nuclear Medicine), outpatient surgeries, retro-authorizations, PCP referrals, and schedule patients for surgery at the discretion of the Director of Otolaryngology. The primary role of the Medical Insurance Coordinator is to triage service requests and obtain the previously described authorizations from health plans and direct orders to site scheduling departments within the Steward Health hospital system.

• Ensure accurate and timely processing of prior authorizations and scheduling in the Department of Otolaryngology.
  • Receives incoming requests from physician practices, hospital staff and patients.
  • Obtains necessary demographic, diagnostic and insurance information.
  • Obtains clinical information required to request prior authorizations. This may be sent by physician practices or obtained directly from the electronic medical record.
  • Obtains prior and retro authorizations, as needed, from Health Plans.
  • Communicates with physician practices and hospital staff as needed
  • Directs properly annotated order in accordance with the Standard Operating Procedure to requested hospital folder for scheduling and confirmation of patient appointment.
  • Meets established quality expectations.
  • Will cross train in referral and MD appointment scheduling
• Teamwork
  • Supports other departmental team members to assure turnaround time expectations are met.
  • Communicates important information to team members, practices, patient assistant center (PAC) and hospital sites as required
  • Contributes to team efforts to improve workflow and efficiency.
• Provide Outstanding Customer Service
  • Goes the extra mile to assure that customer expectations are met.
• Assists with other projects within the department on an "as needed" basis.
• Demonstrates respect and regard for the dignity of all patients, families, visitors, and fellow employees to ensure a professional, responsible, and courteous environment.
  • Commits to recognize and respect cultural diversity for all customers (internal and external).
  • Communicates effectively with internal and external customers with respect of differences in cultures, values, beliefs, and ages, utilizing interpreters when needed.
• Performs other duties as assigned by Department head and Clinical Manager.

Qualifications:

• Education: High school diploma. Associates degree preferred.
• Experience : At least 1-3 years experience in healthcare related field. Radiology scheduling/prior authorization experience preferred.
• Software/Hardware: MS Office, Excel, NIA, AIM, MMIS Referral, ECW, Meditech, Athena and other third-party authorization sites
• Knowledge of insurance, prior authorization, medical terminology, and ICD-10 coding.
• Demonstrated ability to process prior-authorizations, retro-authorization, referral requests, and above-described duties as directed.
• Excellent organizational skills and attention to detail.
• Customer service focused.
• Reliability
• Strong verbal and written communication skills.
• Knowledge of 3rd party payers.
• Requisite poise, judgment, and skills to represent Steward Medical Group to internal and external customers.

Steward Health Care is an Equal Employment Opportunity (EEO) employer, Steward Health Care does not discriminate on the grounds of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, and or expression or any other non-job-related characteristic.

Additional Information

Steward Medical Group is taking additional necessary preparations to ensure patients can receive compassionate care in safe, carefully managed environment with confidence and without fear.

Our Safe and Ready program consists of a rigorous [three-point] standard ensuring patient safety, confidence and convenience.

1. Any COVID-19 related care takes place in designated areas away from other patients and their families.
2. A stringent cleaning policy has been implemented throughout our facilities.
3. A strictly controlled visitor and mask policy is required for patient and colleague safety.

About Steward Health Care System:

Steward Health Cares physician-led model was created to provide patients access to the highest-quality care at a sustainable cost, providing personalized, and coordinated ongoing medical services that positively impact patients physical, emotional, and mental well-being.

Founded in 2010, Steward Health Care is the nations largest accountable care organization (ACO), with more than 5,500 providers and 43,000 health care professionals who care for 12.3 million patients a year through its network of hospitals, urgent care centers, skilled nursing facilities, and behavioral health services. Steward received a perfect 100% quality rating by the Center for Medicare and Medicaid Services (CMS) Medicare Shared Savings Program (MSSP) in 2020.

Based in Dallas, Steward is the largest private, physician-led health care network and currently operates 39 hospitals across Arizona, Arkansas, Florida, Louisiana, Massachusetts, Ohio, Pennsylvania, Texas, and Utah. For more information, visit www.steward.org.