- Obtain initial and continued stay authorizations from Managed Care Organizations (MCOs), Medicare Advantage plans, and other third-party payers.
- Monitor authorization status, track expiration dates, and submit timely extension requests to prevent coverage gaps.
- Collaborate with nursing, therapy, admissions, and case management teams to gather clinical documentation required for authorization requests.
- Maintain accurate authorization records and supporting documentation within the facility's systems.
- Communicate with insurance companies regarding authorization determinations, requests for additional information, and coverage updates.
- Review payer requirements and ensure compliance with authorization guidelines and policies.
- Escalate authorization denials and coordinate with appropriate teams to support reconsiderations or appeals.
- Assist in identifying authorization-related trends, issues, and opportunities for process improvement.
- Support revenue cycle objectives by helping ensure services are authorized and reimbursable.
Microsoft OfficeEHR