About this opportunity
University of California - San Francisco lists this PRACTICE CRD 3 opportunity in san francisco, California. Review the employer’s description below for duties, qualifications and application requirements.
Job description
Job Summary
As a patient-focused organization, UCSF Medical Center exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. UCSF Medical Center seeks faculty and staff that are committed to the values of professionalism, respect, integrity, diversity, and excellence that are integral to our mission.
The PC Authorization Coordinator is primarily responsible for securing financial clearance for the patient, provider, and health system. The coordinator works closely with the administrative, clinical and management teams to support practice operations and customer service recovery and intervention efforts. Provides support for financial clearance functions including authorizations, PAFRs, LOAs billing and RFIs.
Under the direction of the Revenue Manager and/or supervisor, the biller/auth rep will work independently to resolve billing related issues in APeX (Epic) to help maximize payor reimbursement and RVU charge capture. He/she must have an advanced understanding of healthcare terminology, processes and workflow and healthcare billing/authorizations in order to make good decisions and resolve account issues. The incumbent should also have outstanding people skills, including telephone technique, professional appearance, organizational skills, and communication skills (oral and written).
This position will also be responsible for performing detailed review of medical record documentation to answer billing/authorization level questions and will be responsible for working assigned authorization and billing work queues (WQs) on a daily basis to assist in keeping the denials at a minimum. He/she must have the ability to prioritize multiple tasks and work well with all levels of staffing including faculty, management, and coworkers both within and outside of the unit.
The PC is responsible for the maintenance of all routine clerical operations and communications. Adheres to the UCSF House and Telephone Standards and is sensitive to the needs of patients, staff and providers at all times. The PC is a team player who works closely with others and who is flexible in dealing with the changing priorities. Requires a self-reliant individual who synthesizes knowledge of practice operations in order to problem-solve, prioritize and facilitate complex transactions in the course of daily activities.
This position makes a difference for patients in an outpatient care unit by providing excellent customer service, facilitating and ensuring the accuracy of the information flow between medical, hospital staff and departments to maximize unit efficiency. The PC is required to work at any UCSF campus as needed and scheduled.
New & Follow-Up Patient Authorizations 5%
* On a daily basis review and works authorization work queues documenting activities within the authorization record.
* Reviews referral work queues as needed to monitor incoming volume.
* If a practice utilizes an external system for specialty authorizations, such an electronic log, the representative maintains the electronic log but also creates an authorization record for accurate tracking and documenting financial securitization.
* Enters or updates patient registration information as needed to correct errors.
* Ensure appropriate insurance is loaded and facilitates authorization acquisition. Verifies insurance and referral/authorization information from previous appointments as needed to facilitate subsequent authorizations. Schedules and coordinates any pre-appointment tests or appointments.
* Schedules and coordinates any pre-appointment tests or appointments.
* Creates HARs (Hospital Account Records) as needed to facilitate authorization loading.
* Creates a professional and positive first impression for patients and referring physicians. Demonstrates good judgment and common sense.
Advanced New & Follow-Up Patient Authorizations 15%
* Secures outside medical records, as needed for authorizations makes quick determination on services known for long authorization turn around or not needing the authorization. as to which physician can best evaluate the patient.
* Understands and is able to prioritize authorizations based on clinical complexity, diagnosis and current treatment status to ensure authorizations are prioritized appropriately. Has expertise in understanding payor timelines to know when authorizations need to be started urgently due to payor constraints and ensure that as many patients are authorized successfully as possible.
* Informs practice personnel, providers are patients as needed of authorization delays and denials in a timely manner.
* Escalates authorization delays ASAP for services to patients within 72-hour window or for urgent or medically sensitive services.
Surgical Authorization Coordinator 5 % * depends on practice
* Coordinates securing authorizations for all outpatient and inpatient surgeries for the surgical practice.
Captures appropriate CPT and ICD-10 codes, or coordinates with provider, or certified professional coder to acquire accurate codes.
* Interacts with clinical and academic staff to coordinate surgical activities depending on authorization availability.
* Coordinates and manages complex referrals and authorizations including LOAs, Psych, Lab, Imaging and other specialties.
Advanced Surgical Authorizations 15%
* Coordinates with practices, PAR, Admitting and other related departments to coordinate securing all necessary authorizations. This could include procedure, admissions, medications, labs, imaging and testing services. Additionally, many cases require complex admission, discharge and planning coordination involving hospital reservations and authorizations related to study patients on protocol, transfers from outside hospitals and post transfer urgent authorizations and surgical planning.
* Works with patients and staff to confirm availability and accuracy of medical information within APeX and to ensure documentation supports medical necessity.
* Secures authorization for surgical procedures and coordinates with Hospital Admissions Department as needed. Acts as primary liaison to procedure billing team to coordinate updated authorizations and or TARs for mid procedure changes or additions.
* Ensures compliance with Medical Center bylaws and Regulations ensuring the diagnosis is confirmed before authorization through formal review of relevant clinical information. The authorization coordinator is the sole person to ensure authorization is secured for the organization.
* Coordinates advanced authorization for complex services such as psychotherapy, psychiatry, IVF, serial service testing and imaging.
* Must have extensive payor expertise to coordinate complex authorizations for multiple surgical practices (i.e. Ortho Surgery, Urology Surgery etc.) Revenue Cycle Required Qualifications
High School graduate or equivalent with four years related experience; or college degree and 6 months related experience; or equivalent combination of education and experience.
Successfully passes fingerprinting protocol and is approved to be a cash collector if applicable.
Strong computer skills, including basic keyboarding skills, and experience with at least two Office-type software programs (i.e., Outlook, Word and Excel). Proven ability to navigate through multiple patient records systems. Able to sit at a computer terminal with telephone headphones for extended period of time.
Ability to analyze situations, prioritizes, and develops solutions and makes recommendations.
Ability to work with minimal supervision
Ability to use good judgment and work independently, at times under the pressure of deadlines
Ability to access situations prioritizes workload, develop solutions and make recommendations.
Excellent customer service and communication/interpersonal skills, both over the telephone and directly.
Able to sit at a computer terminal with telephone headphones for extended periods of time.
Basic math skills required.
Proven ability to deal with a wide variety of individuals;
Ability to deal sensitively and effectively with patients.
Excellent organizational and problem-solving skills.
Strong writing skills to include the ability to compose, edit, and proof a wide variety of documents.
Demonstrated administrative/office coordination skills.
Demonstrated knowledge of medical practice terminology.
Within six months of start date, based upon completion of training, the Supervisor, completes the proficiency checklist with the employee. This includes the following areas if applicable Referrals (Incoming referral entry) and handling all referral WQs
Schedule surgeries
Work applicable work queues
Enter/edit outside test results
Messaging (CRM) if applicable
2nd calls in CRM if applicable
Telephone encounters
My open encounter
Staff message
New message
Route Patient advice request to providers (My Chart)
Patient Schedule (My Chart)
Letters
Pools
Patient look up
Check in process
Check out process
Comment field
Quick note
Scanning
Preferred Qualifications
Demonstrated experience in health care (may include medical, dental or veterinary) in the following areas: patient scheduling, insurance verification, medical record data abstraction, or patient financial services.
Prior experience with appointment, ancillary service or surgical scheduling or a combination of all three.
Bi-lingual or multi-lingual capability (Spanish, Cantonese, and Russian) strongly preferred.
Prior experience with EPIC.
Required Qualifications
High School graduate or equivalent with four years related experience; or college degree and 6 months related experience; or equivalent combination of education and experience.
Successfully passes fingerprinting protocol and is approved to be a cash collector if applicable.
Strong computer skills, including basic keyboarding skills, and experience with at least two Office-type software programs (i.e., Outlook, Word and Excel). Proven ability to navigate through multiple patient records systems. Able to sit at a computer terminal with telephone headphones for extended period of time.
Ability to analyze situations, prioritizes, and develops solutions and makes recommendations.
Ability to work with minimal supervision
Ability to use good judgment and work independently, at times under the pressure of deadlines
Ability to access situations prioritizes workload, develop solutions and make recommendations.
Excellent customer service and communication/interpersonal skills, both over the telephone and directly.
Able to sit at a computer terminal with telephone headphones for extended periods of time.
Basic math skills required.
Proven ability to deal with a wide variety of individuals;
Ability to deal sensitively and effectively with patients.
Excellent organizational and problem-solving skills.
Strong writing skills to include the ability to compose, edit, and proof a wide variety of documents.
Demonstrated administrative/office coordination skills.
Demonstrated knowledge of medical practice terminology.
Within six months of start date, based upon completion of training, the Supervisor, completes the proficiency checklist with the employee. This includes the following areas if applicable Referrals (Incoming referral entry) and handling all referral WQs
Schedule surgeries
Work applicable work queues
Enter/edit outside test results
Messaging (CRM) if applicable
2nd calls in CRM if applicable
Telephone encounters
My open encounter
Staff message
New message
Route Patient advice request to providers (My Chart)
Patient Schedule (My Chart)
Letters
Pools
Patient look up
Check in process
Check out process
Comment field
Quick note
Scanning
Preferred Qualifications
Demonstrated experience in health care (may include medical, dental or veterinary) in the following areas: patient scheduling, insurance verification, medical record data abstraction, or patient financial services.
Prior experience with appointment, ancillary service or surgical scheduling or a combination of all three.
Bi-lingual or multi-lingual capability (Spanish, Cantonese, and Russian) strongly preferred.
Prior experience with EPIC.
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.