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Prior Authorization Coordinator

Job ID 146416 Date posted 04/22/2018

Position Summary:

The Prior Authorization Coordinator is responsible for coordinating comprehensive data elements, insurance verification, and clinical information for prescription pre-authorization management. Maintains knowledge of third party reimbursement regulations and medical terminology. Provides customer support and resolves problems that may arise as a result of customer inquiries. Assures continuity of care for patients receiving services through onsite pharmacies.

Essential Duties & Responsibilities including but not limited to:
1) Contacts insurance companies to determine eligibility and benefits for requested services
2) Drafts various correspondence letters and sends to insurers as necessary.
3) Provides information and answers to patient/caregiver questions and refers to clinician when appropriate or requested.
4) Follows up with the provider, patient, or insurance company if there are insurance coverage issues in order to obtain financial resolution
5) Obtains necessary clinical documentation from the requesting provider to use in the prior-authorization process , meet insurer contractual requirements (where applicable), and to optimize patient outcomes
6) Identifies insurance treatment requirements and assures the requirements are met for prior authorization approval.
7) Maintain patient records in a timely and complete manner.
8) Becomes proficient in the use of ICD-9, ICD-10 and CPT codes
9) Accurately utilize applicable computer software and equipment for access processing
10) Receives refill requests and queues up prescription renewals for patients with whom the coordinator has ongoing contact.
11) Builds strong work relationships with departmental staff.
12) Follows established departmental rules, procedures, policies, quality-improving objectives, environmental, safety and/or infection controlling standards.
13) Attends departmental meetings and/ or documents review of meeting minutes
14) Responsible for own professional development including meeting all requirements for continuing education, and keeping abreast of current professional literature, both from a clinical and medication safety perspective.
15) Actively participates in continuous performance improvement activities of the department, including providing suggestions on how to improve day-to-day operations
16) Has completed all organizational and departmental competency requirements.
17) Performs assigned projects in an efficient and timely manner
18) Performs additional tasks as assigned.

Qualifications

Minimum Qualifications:
Education: High School Diploma or GED

Licensure, Certification & Registration: State of Massachusetts Registered Pharmacy Technician; PTCB Certification for Pharmacy Technicians.

Experience: 2+ years of clinical experience within a healthcare environment (e.g. hospital, retail, managed care etc.)
Experience in prior authorization submission process

Skills, Knowledge & Abilities: Knowledge will include, at minimum, prior-authorization workflows, payer relations, prescription claims adjudication, and general reimbursement procedures.
Uses excellent customer service, written and oral communication skills.
Ability to understand and follow specific instructions and procedures;
Superior communication skills
Demonstrated knowledge of insurances, drug formularies and drug products
At least one year of pre-cert experience, including navigating websites for online benefit reviews
Excellent clerical, computer, multi-tasking, resource management and phone skills
Skill in the use of personal computers and related software applications.
Creative thinking and problem solving skills, and ability to work well under pressure (most of the paperwork is time sensitive)
Ability to understand importance of and respect for the confidentiality of all patient information in accordance with applicable standards and regulations.
TEAM PLAYER and willing to be diversified

Shift

DAYS

About Lahey Health

At Lahey Hospital & Medical Center, as one of the world's premier health care organizations, we provide superior health care leading to the best possible outcome for every patient. We exceed our patients' high expectations for service each day. We also help advance medicine through research and the education of tomorrow's health care leaders

We care for our patients with compassion and openness, unsurpassed expertise, a drive for continuous learning improvement, and with respect, caring, teamwork, excellence and commitment to doing our personal best.

Join our team and our mission of excellence by applying today!

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