LPN Authorization Coordinator - West Monroe, LA

POSITION SUMMARY

C ommunicat es with payors to obtain authorization for all patients as required and pending post-acute placement . Provide clinical information to payors as required under the direction of UR nurse. Document s authorization numbers, concurrent denial s , attempts to overturn denials . C oordinat ion of concurrent denial appeals between ph ysicians and insurance providers. Collaborates with Patient Access, Case manager, UR n urse and physicians to facilitate obtaining authorizations. Timely escalates any potential disputes or denials to Director of Case Management or UR nurse.

DUTIES AND RESPONSIBILITIES

• Validates daily that all Managed care/Commercial cases have an appropriate authorization and notify DCM or UR nurse of variances
• Document authorization and denial information in Care Management documentation system
• Submits initial clinical information within 24 hours of admission as directed by UR nurse
• Concurrently make sure all clinical needed by payors or updates provided by alerting UR nurse and/or DCM
• Coordinate Peer-to-Peer arrangements between physicians and insurance providers on denials when ap propriate a nd document outcome
• Maintains confidentiality of patient/physician/personnel information/hospital proprietary information
• Performs other duties as assigned
• Maintains licensure/certification, BLS , etc. as required
• EDUCATION AND EXPERIENCE
• Experience with Microsoft Office, Word, Excel, and Outlook required
• Experience with EMR strongly preferred
• Manages time effectively, sets priorities, and consistently meets deadlines
• Excellent communication skills, both written and oral required
• Demonstrates initiative and pro-active approach to problem resolution
• Demonstrates good organizational skills and attention to detail
• Ability to work independently with little supervision
• Louisiana licensed LPN required
• 2 to 4 years' healthcare experience preferred

Please indicate whether you have ever been convicted of a crime, including any misdemeanors and/or DUI/DWI. (Criminal conviction(s) will not automatically exclude you from consideration for employment).