Medication Prior Authorization Coordinator
Develops and directs implementation of standards, processes and systems to enhance quality, consistency, efficiency, and timeliness of responsibilities within the Centralized Medication Prior Authorization Department. Serves as a technical expert and a resource to staff & patients. Responsible for ensuring the appropriate levels of complex patient medication authorizations to facilitate efficient operations, expeditious reimbursement and optimal customer service satisfaction. Consistently demonstrates the core values of Children's Health System of Texas and serves as a role model to other employees.
Responsibilities:
- Serves as preceptor for on-boarding new team members to the department
- Provides guidance, feedback and training to staff on multiple processes, payers and systems; monitors work queue assignments and assess productivity
- Possesses the ability to interpret and demonstrates compliance with performance standards, regulations and policies and procedures and third-party contracts, guidelines
- Coordinates the implementation of team-oriented process improvement initiatives for the department and organization
- Resolves complex patient issues, responds to questions on reimbursement and serves as a resource to patient access specialists as needed, including on-the-job training
- Acts as liaison to resolve complex patient medication authorization issues
- Performs routine Audits and Quality Assurance for staff
- Clerical functions include but are not limited to the management of phone lines, faxing, documentation of information received by phone or fax, retrieval of medical records, scanning of documents and other clerical functions not listed.
- Collect insurance benefit information from insurance representative or web portal to make determination of patient's insurance benefits and coverage options.
- Continually communicate with and advocate for patients and families, Providers, multidisciplinary team members and payers to facilitate coordination of submissions and approvals
- Punctual notification to physicians, clinical staff and customers regarding additional requested information from payor regarding medications authorizations to reduce approval delays. (i.e. Peer to Peer, letter of medical necessity, document signatures)
- Demonstrates the components of the Children's Health System Vision, Mission and The Children's Way Values
- Follows all safety rules while on the job, reports accidents promptly and corrects minor safety hazards
- Performs all other duties as assigned
- Qualifications: Ability to multitask, work on multiple authorizations at once, excellent organizational skills, strong interpersonal skills, ability to type 65+ WPM, ability to handle challenging situations in a professional manner, superior written and communication skills, ability to adapt in a dynamic work environment, learns quickly, solves problems, and makes decisions
Work Experience:
- At least 5 years customer service experience with two years of healthcare experience including insurance verification and/or billing required
- At least 5 years Extensive Knowledge of policies and guidelines utilized by all categories of health insurance companies, government agencies employer benefits departments as they relate to medication prior authorizations. required
- EPIC proficiency required
Education:
- Two-year Associate's degree or equivalent experience required
Licenses and Certifications:
- National Association of Healthcare Access Management CHAA Certification 1 Year preferred
A Place Where You Belong:
We put our people first. We welcome, value, and respect the beliefs, identities and experiences of our patients and colleagues. We are committed to delivering culturally effective care, creating meaningful partnerships in the communities we serve, and equipping and developing our team members to make Children's Health a place where everyone can contribute.
Holistic Benefits How We'll Care for You:
- Employee portion of medical plan premiums are covered after 3 years.
- 4%-10% employee savings plan match based on tenure
- Paid Parental Leave (up to 12 weeks)
- Caregiver Leave
- Adoption and surrogacy reimbursement
As an equal opportunity employer, Children's Health does not discriminate against employees or applicants because of race, color, religion, sex, gender identity and expression, sexual orientation, age, national origin, veteran or military status, disability, or genetic information or any other Federal or State legally-protected status or class. This applies to all aspects of the employer-employee relationship including but not limited to recruitment, hiring, promotion, transfer pay, training, discipline, workforce adjustments, termination, employee benefits, and any other employment-related activity.