Job Description:

The Access Coordinator gathers necessary insurance information and uses expertise to translate the information provided by the patient/guarantor into the computer system, resulting in accurate claim submissions.Gather necessary insurance information, use expertise to translate the information provided by the patient/guarantor into the computer system with the result of an accurate claim submission. May be responsible for some or all of the following: insurance verification, ICD 10 or HCPC code selection, prior authorization, pre-certification, medical necessity determination, referrals, workers compensation authorization, service estimates, patient communication when services are not covered, pre-service collections. Key Responsibilities:Prepares and submits payer-specific prior authorizations and referrals in alignment with relevant guidelines and medical policy criteriaAccurately identifies required insurance verification and medical documentation in accordance with payer policyCollaborates with clinicians and medical practitioners to obtain all necessary information for successful authorization approvalThoroughly documents all interactions and actions related to insurance processes within the electronic Medical Record (EMR) systemRegularly reviews and monitors assigned work queues, identifying, and focusing on accounts with the highest financial reimbursement riskAdapts to urgent clinical needs while maintaining high-quality work outputs within specified timelinesCommunicates with patients as needed to facilitate medical clearanceDevelops pre-service estimates and supports pre-service collectionsSupports the review of prior authorization requests that do not initially meet criteria and works collaboratively with relevant stakeholders to resolve issues or coordinate necessary clinician-to-health plan interventions