As a Prior Authorization/ Patient Care Coordinator you’ll be responsible for; Heavy data entry; verifying that an Authorization is valid for service and submitting authorizations to multiple insurance plans. Heavy attention to detail. Positive Team player mentality. Other task as assigned by supervisor.

REQUIRED EDUCATION/TRAINING/PROFESSIONAL EXPERIENCE – CUSTOMER SERVICE REPRESENTATIVE:

• High School degree or equivalent G.E.D required
• Knowledge of Microsoft Word, Excel; ability to work with multiple information systems
• Knowledge of medical and pharmaceutical terminology (ICD-10, J-codes)
• Medical Prior authorization Required
• Pharmacy or medical office experience preferred
• HMO, Medicare Insurance knowledge Required
• 45 wpm

EXPECTED PROFESSIONAL COMPETENCIES:

• General knowledge of pharmacy and healthcare laws and regulations
• Engages in appropriate continuing professional development
• Practices patient centered care
• Practices professionally
• Practices legally
• Practices ethically
• Decision making skills
• Team working skills
• Communication skills
• Strong Problem Solving skills
• Customer Service skills
• Detail oriented

ROLES AND RESPONSIBILITIES

• Initiate Prior authorizations along with work with MD contacts to make sure patients authorizations are being submitted in a timely manner.
• Ensure the accuracy of prescription and patient data entered into various systems by verifying patient, drug, quantities, directions, day’s supply, insurance, physician data.
• Create physician profile in computer systems, demographics
• Keep current and compliant with statutes, rules and regulations related to pharmacy
• Participate in continuous improvement and quality assurance programs
• Input insurance information, pharmacy and medical
• Resolve aspects of specialty pharmacy and medical including Medicare, Medicaid, PBM, PPO and IPA and communicate with payers and advise patients or physician of results when needed.
• Communicate with various pharmacy departments as needed to coordinate timely prescription adjudication to meet schedules.
• If necessary, contact physician offices for refill authorizations
• Report errors, omissions or incidents to pharmacists
• Participate in quality program initiatives and improvement activities
• Comply with all regulatory requirements, including HIPAA/HITECH
• Other responsibilities as assigned by Management

PHYSICAL DEMANDS:

Frequent immobility and/or sitting required for extended periods of time. Some bending and stooping required. Requires manual dexterity to operate keyboard, calculator, photocopy machine, and other office equipment. Requires eyesight correctable to 20/20 to read reports and computer terminals. Requires hearing within normal range for telephone use. Occasional high stress work.

WORK ENVIRONMENT:

Normal office environment.

Experience:

• Medical Assistants with Prior authorization Knowledge are Encouraged to apply
• Medical Office Experience: (Preferred but not Required)

Job Type: Full-time

Job Type: Full-time

Salary: $19.00 - $22.00 per hour DOE monthly bonus after probation period

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday

Job Type: Full-time

Pay: $18.00 - $22.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Weekly day range:

• Monday to Friday

Experience:

• Medical terminology: 1 year (Preferred)
• Medical Authorization: 1 year (Required)

Work Location: In person