Menu

Preauthorization Coordinator

  • HOMELINK
  • Waterloo, IA
  • Full Time
Apply Now
HOMELINK Logo

Job Description

Collaborates with other healthcare providers to evaluate the medical necessity of care. Reviews clinical information to make accurate, affirmative medical necessity decisions for Durable Medical Equipment (DME) and other healthcare services as delegated by Delegator, using approved Delegator’s clinical criteria and regulatory guidelines. Also, performs telephonic screening and interview documentation as necessary for patients in the coordination of their services.

Responsibilities

These are the responsibilities expected of an applicant interested in this position.

  1. Receives incoming calls and transmissions, in accordance with Delegator and HOMELINK Service Level Agreements (SLA’s). Accurately enters preauthorization received by any means, including, but not limited to telephone, fax, email, or HOMELINK’s web site portal within approved Delegator’s clinical criteria and regulatory guidelines. Submits all preauthorization determinations to Delegator in the format prescribed by Delegator.
  2. Makes accurate and consistent preauthorization determinations including collecting appropriate clinical information, applying appropriate Delegator’s clinical criteria, consulting with Delegator’s Medical Director, and assisting Delegator with communicating preauthorization decisions to providers and patients in accordance with policies and procedures.
  3. Reviews all potential medical necessity denials and refers them to Delegator’s Medical Director or physician designee for a final preauthorization determination.
  4. Maintains a working knowledge of NCQA or other nationally recognized accreditation body and regulatory standards (i.e., CMS and state Departments of Insurance), relative to utilization review and management, and consistently delivers utilization review and management activities consistent with NCQA or other nationally recognized accreditation body and regulatory standards.
  5. Ability to communicate complex information verbally and in written form that may include policies and procedures and/or technical clinical criteria, and ability to participate in the implementation of Delegator’s strategic programs and projects.
  6. Performs accurate data entry for assigned tasks, including but not limited to preauthorization data entry.
  7. Adheres to strict preauthorization turnaround times as specified by the Delegator.
  8. Maintains current knowledge of Delegator’s utilization review and management policies and procedures, clinical criteria, NCQA or other nationally recognized accreditation body standards, and regulatory guidelines established by CMS, or other nationally recognized accreditation body, and state Departments of Insurance.
  9. Performs all functions with integrity. Provides internal and external customer service in a cooperative, respectful, and professional manner.
  10. Follows strict confidentiality and HIPAA privacy and security guidelines.

*Key Responsibilities do not include issuing denials of preauthorization requests

Qualifications

Applicants are expected to meet these qualifications to be considered for this position.

  1. Ability to multitask and prioritize
  2. Possess strong time management and organization skills
  3. Detail oriented
  4. Work well under pressure and be punctual
  5. Flexible with the ability to routinely adapt to change
  6. Team player with excellent communication skills

Find out more about HOMELINK at vgmhomelink.com

Apply Now

Back to Top