Prior Authorization Coordinator
Much like in medical billing, Prior Authorization Coordinators (sometimes called Financial Counselors) are dealing primarily with insurance companies and the healthcare facility or providers office. A prior authorization coordinator is usually the liaison between the front-office of the clinic, the patient, and the provider. It is the coordinators job to ensure that the services the provider deems appropriate for the patients continued care is reimbursed by the insurance company. This role requires extensive knowledge of procedure codes (HCPCS and/or CPT) to ensure that the patient can receive the treatment needed. You should have an in depth knowledge of the insurance plans in your demographic area to be good at this role and someone who is very comfortable working directly with providers. For someone with front-desk healthcare experience, this is a great role to get started on the business side of healthcare because you are transitioning from a primarily patient facing role, to balancing insurance knowledge with communicating with the patient and provider. You often have to be the bearer of bad news to both the provider and the patient, if an insurance company denies a service. If you are looking to transition to a medical coding role, this will prepare you for appropriately getting experience querying (asking) the provider for information to support the medical necessity of the patients planned care.
PayScale.com lists Prior Authorization responsibilities including:
Authorization Coordinator Tasks
- Interview and assist patients with authorization documents, as appropriate.
- Maintain appropriate logs or reports according to professional, state, and federal requirements.
- Monitor and track patient authorizations, informing supervisor of any expired dates.
- Ensure payment for services by verifying benefits with insurance provider.
- Obtain, review and input insurance authorization and referrals prior to patient services.
- Quote rates for scheduled or planned procedures
- Notifying patients of authorizations that do not meet criteria for coverage