Job Description

Job Description

Job Description

Description:

DUTIES

Performs a combination, but not necessarily all, of the following duties:

• Obtains information necessary to complete the prior-authorization.
• Completes the prior authorization process for multiple providers- submits required documentation, tracks status of requests, schedules patients when approval received.
• Responsible for contacting patients and pharmacies to inform them of outcome or inform patients of medication changes made by physicians and/or providers.
• Coordinates with insurer to verify that patient is covered by insurance, coverage limitations, and eligibility for services to be provided including specialty medications benefit verification and prior authorization for all providers.
• Consistently follows up with insurance company on the status of prior authorizations for medications and medical devices
• Develops and maintains relationships with pharmaceutical and medical device representatives
• Responsible for tracking, obtaining, and extending authorizations from various carriers in a timely manner, requesting input from appropriate team members as needed.
• Researches and works with staff in resolving and resubmitting denied claims including a review of timely submission and other processing procedures
• Responds professionally to all inquiries from patients, staff, and payors in a timely manner
• Accurately documents patient accounts of all actions taken
• As necessary, negotiates a work improvement plan with management to raise work quality and quantity to standards
• Completes additional projects and duties as assigned
• Ability to meet established deadlines timely, accurately and with a sense of urgency
• Other duties as assigned/ required.

SUPERVISION

Work is performed under general supervision from the Department Manager of the Clinical Call Center unit.

EQUIPMENT

Must be familiar with computer technology and comprehend basic computer functions.

WORKING CONDITIONS

Work is performed in an office, and/or clinic environment.

The above statements are intended to describe the general nature and level of work performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. Management retains the right to add or to change the duties of the position at any time.

SKILLS AND QUALIFICATIONS

Required abilities and dispositions:

• High personal motivation, self-management, and detail-orientation; ability to take responsibility in meeting deadlines and making progress without direct supervision.
• Strong spoken and written communications skills.
• Capacity and will to learn new software, device methods, and work routines quickly; flexibility in responding to new department opportunities as they arise.
• Motivation to engage in and manage a wide range of intellectual and physical work.
• Strong existing computer skills with Microsoft Office statistical software, and general Internet and electronic communications.
• Articulate and tactful communications skills; readiness to meet and work directly with clients.

PHYSICAL REQUIREMENTS

• Must be able to sit for long periods of time, must have manual dexterity to work computer systems and keyboard.- Frequently
• Must be able to have face to face conversation with patients and staff.- Frequently
• Must be able to lift 25 lbs.- Occasionally
• Must be able to stand for a maximum of 30 minutes at a time- Occasionally

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Health insurance
• Life insurance
• Paid time off
• Retirement plan
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday
• No weekends
• Overtime

Education:

• High school or equivalent (Preferred)

Work Location: In person

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