• Job Description

  Req#: 2403005170

  Summary

  The Authorization Coordinator works under direction of Social Worker or Case Manager RN.
  The Authorization Coordinator's responsibilities include but not limited to the following actions:

  • Follow up on patient accounts for when authorization for stay is required
  • Fax numbers to Send clinical reviews
  • Follow up on each account during the stay and on discharge for authorization - document in the electronic system
  • The Authorization Coordinator escalates any potential disputes or denial of accounts to director of Case Management or designee
  • Trends disputed claims by at least payor and physician (e assist in obtaining authorization for patient discharged to Skilled Facilities or other post acute care that require authorization)
  • Trend by payor and service any authorization not obtained by end of day
  • Trend and Track on denial prevention
  • Other duties as assigned

  Responsibilities

  Utilization Management

  The Authorization Coordinator validates patient’s demographic and payer information with patient/family and notifies Patient Access immediately if any corrections are needed

  Validates that all commercial/managed care discharges have an authorization for status and level of care provided and notifies Director of Case Management (DCM) of variances

  The Authorization Coordinator provides Important Message follow up letter to Medicare patients per Tenet policy and under the direction of the RN Case Manager or SW Transition Management

  Makes referrals for post-acute services under the direction of the RN Case Manager or Social Work (SW) staff utilizing the electronic Tenet Case Management system

  Provides patients and families with choices of post-acute providers per Tenet policy

  Responds to post-acute providers timely and completes referrals per Tenet policy

  Documents and communicates all elements of the post-acute referral to the RN Case Manager or SW and the healthcare team, patient/family and post-acute providers

  Completes tasks as assigned by RN or LVN Case Manager and/or SW staff

  Makes copies, send faxes and complete phone calls to arrange post-acute services and to ensure that appropriate hospital information is communicated to post-acute providers

  Documents all referrals and tasks in the Tenet Case Management system per Tenet policy

  Education - Provides patients and healthcare team information regarding resources and benefits available to the patient along with the economic impact of care options

  Compliance - Adheres to federal, state, and local regulations and accreditation requirements impacting case management scope of services

  The Authorization Coordinator adheres to department structure and staffing, policies and procedures to comply with the CMS Conditions of Participation and Tenet policies

  Qualifications

  Education

  Required: High School Graduate or equivalent
  Preferred: Associates or Bachelors degree

  Experience

  Required: Two (2) years of experience in clerical or healthcare field.
  Preferred: Acute hospital experience.

  Certifications

  Preferred: Paramedic, EMT or Certified Nursing Assistant

  #LI-NS1

  Tenet complies with federal, state, and/or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date. If you receive an exemption from the vaccination requirement, you will be required to submit to regular testing in accordance with the law.

  Qualifications

  Education:

  Required: High school diploma or equivalent
  Preferred: Associate or bachelor's degree

  Experience:

  Required: 2 years of experience in clerical or healthcare field
  Preferred: Acute hospital or health plan experience

  Certifications:

  Preferred: Paramedic, EMT or Certified Nursing Assistant

  Physical Demands:

  Lift/position up to 25 lbs. Push/pull up to 25 lbs. of force. Frequent sitting. Moderate standing, walking, reaching, stooping, and bending. Manual dexterity, mobility, touch, auditory to perform all the related duties of the position.

  Responsibilities

  Validates patient’s demographic and payer information with patient/family, and notifies Patient Access immediately if any corrections are needed. Validates that all commercial/managed care discharges have an authorization for status and level of care provided, and notifies Director of Case Management (DCM) of variances. Provides Important Message follow up letter to Medicare patients per Tenet policy. and under the direction of the RN Case Manager or SW. Makes referrals for post-acute services under the direction of the RN Case Manager or Social Work (SW) staff utilizing the electronic Tenet Case Management system. Provides patients and families with choices of post-acute providers per Tenet policy. Responds to post-acute providers timely and completes referrals per Tenet policy. Documents and communicates all elements of the post-acute referral to the RN Case Manager or SW and the healthcare team, patient/family, and post-acute providers. Completes tasks as assigned by RN or LVN Case Manager and/or SW staff. Makes copies, sends faxes, and completes phone calls to arrange post-acute services and to ensure that appropriate hospital information is communicated to post-acute providers. Documents all referrals and tasks in the Tenet Case Management system per Tenet policy.
  Education
  Provides patients and healthcare team information regarding resources and benefits available to the patient along with the economic impact of care options.
  Compliance
  Adheres to federal, state, and local regulations and accreditation requirements impacting case management scope of services. Adheres to department structure and staffing, policies and procedures to comply with the CMS Conditions of Participation and Tenet policies.

• About the company

  Tenet Healthcare Corporation is a multinational investor-owned healthcare services company based in Dallas, Texas, United States.

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