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The Authorization Coordinator coordinates communication with admitting, case management, patient financial services, and payers to ensure all inpatient services provided by the hospital are authorized by appropriate payer. He/She will facilitate the timely transmission of concurrent and discharge reviews to the appropriate payer and ensures that authorized days are obtained and documented.

The Authorization Coordinator coordinates communication with admitting, case management, patient financial services, and payers to ensure all inpatient services provided by the hospital are authorized by appropriate payer. He/She will facilitate the timely transmission of concurrent and discharge reviews and physician discharge documentation to the appropriate payer and ensures that authorized days are obtained and documented.

Essential Duties:

• Collaborates with admitting personnel to ensure all insurance contacts are identified and documented in PM Conversations within 2 working days of admission.
• Coordinates retrospective reviews by receiving review requests, gathering and dissemination documentation as necessary. Enters data in a timely manner, ensuring that all data is accurate.
• Builds and maintains good working relationships with all payer staff, physicians, and IPA/Medical Groups
• Assists with denial management to identify opportunities to improve department processes.
• Maintains awareness of payer/reimbursement practices/requirements.
• Assists with orientation of new personnel regarding payer communication.
• Identifies opportunities to improve department workflow and process regarding payer communication.)
• Documents results of peer-to-peer outcomes in PM Conversations
• Adheres to hospital policies, procedures, and standards.
• Receives denials and coordinates peer to peer communication.
• Notifies RN utilization review nurses of any changes or updates in payer/health plan.
• Elevates issues impending timely authorization retrieval or denials to supervisor immediately.
• Responds to insurance requests for clinical reviews.
• Maintains communication with payers and appropriate IPA/outside case manager.
• Inputs authorization data into spreadsheets to generate reports for analysis.
• Sends physician Discharge Summaries to payer no later than 3 days post discharge to ensure payment.
• Reviews all insurance cases upon discharge to ensure clinical reviews have been completed and sent to the appropriate payer.
• Reviews daily census to identify all insurance patients.
• Performs other duties as assigned.

Required Qualifications:

• High school or equivalent

• 2 years Previous experience in medical claims, prior authorization, or patient access
• Experience with computer data entry and spreadsheets.
• Prior experience in a healthcare setting (ie hospital, physician office, managed care)

• Good verbal and written communication skills.
• Medical terminology knowledge.
• Ability to be self directed and work with minimal supervision.
• Ability to work collaboratively with multiple personnel and prioritize multiple tasks.
• Knowledge of insurance plans

Preferred Qualifications:

• Licensed Vocational Nurse - LVN (CA DCA) *Preferred for Case Management departments.

Required Licenses/Certifications:

• Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)

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About University of Southern California (USC)

USC is the leading private research university in Los Angeles—a global center for arts, technology and international business. With more than 47,500 students, we are located primarily in Los Angeles but also in various US and global satellite locations. As the largest private employer in Los Angeles, responsible for $8 billion annually in economic activity in the region, we offer the opportunity to work in a dynamic and diverse environment, in careers that span a broad spectrum of talents and skills across a variety of academic and professional schools and administrative units. As a USC employee and member of the Trojan Family—the faculty, staff, students, and alumni who make USC a great place to work—you will enjoy excellent benefits, including a variety of well-being programs designed to help individuals achieve work-life balance.

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