LPN Authorization Coordinator

DUTIES AND RESPONSIBILITIESValidates daily that all Managed care/Commercial cases have an appropriate authorization and notify DCM or UR nurse of variancesDocument authorization and denial information in Care Management documentation system Submits initial clinical information within 24 hours of admission as directed by UR nurseConcurrently make sure all clinical needed by payors or updates provided by alerting UR nurse and/or DCMCoordinate Peer-to-Peer arrangements between physicians and insurance providers on denials when appropriate and document outcomeMaintains confidentiality of patient/physician/personnel information/hospital proprietary informationPerforms other duties as assignedMaintains licensure/certification, BLS, etc. as required     EDUCATION AND EXPERIENCEExperience with Microsoft Office, Word, Excel, and Outlook requiredExperience with EMR strongly preferredManages time effectively, sets priorities, and consistently meets deadlinesExcellent communication skills, both written and oral requiredDemonstrates initiative and pro-active approach to problem resolutionDemonstrates good organizational skills and attention to detail Ability to work independently with little supervisionLouisiana licensed LPN required2 to 4 years' healthcare experience preferredPlease indicate whether you have ever been convicted of a crime, including any misdemeanors and/or DUI/DWI.

POSITION SUMMARYCommunicates 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. Documents authorization numbers, concurrent denials, attempts to overturn denials. Coordination of concurrent denial appeals between physicians and insurance providers. Collaborates with Patient Access, Case manager, UR nurse and physicians to facilitate obtaining authorizations. Timely escalates any potential disputes or denials to Director of Case Management or UR nurse.DUTIES AND RESPONSIBILITIESValidates daily that all Managed care/Commercial cases have an appropriate authorization and notify DCM or UR nurse of variancesDocument authorization and denial information in Care Management documentation system Submits initial clinical information within 24 hours of admission as directed by UR nurseConcurrently make sure all clinical needed by payors or updates provided by alerting UR nurse and/or DCMCoordinate Peer-to-Peer arrangements between physicians and insurance providers on denials when appropriate and document outcomeMaintains confidentiality of patient/physician/personnel information/hospital proprietary informationPerforms other duties as assignedMaintains licensure/certification, BLS, etc. as required     EDUCATION AND EXPERIENCEExperience with Microsoft Office, Word, Excel, and Outlook requiredExperience with EMR strongly preferredManages time effectively, sets priorities, and consistently meets deadlinesExcellent communication skills, both written and oral requiredDemonstrates initiative and pro-active approach to problem resolutionDemonstrates good organizational skills and attention to detail Ability to work independently with little supervisionLouisiana licensed LPN required2 to 4 years' healthcare experience preferredPlease 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).