Description
Position: Prior Authorization Coordinator (Primary Care/Harbor Care Health & Wellness Center)
Department: Harbor Care Health and Wellness Center
Reports to: Director of Nursing
Pay Status: Full Time
Work Schedule: Monday through Friday; 8:00am - 5:00pm. Will be required to work occasional evenings and Saturdays.
Location: Nashua- 45 High Street
The Job:
Do you want to make sustainable change in our community? Harbor Care is seeking a talented and committed Prior Authorization Coordinator to help further our mission.
About Harbor Care:
Harbor Care, formerly known as Harbor Homes and the Partnership for Successful Living affiliates, is an innovative health and human services non-profit organization that provides housing, healthcare, home health, behavioral health, addiction treatment, and more in collaboration with many community partners. Harbor Care is the new shared name of Harbor Homes, Keystone Hall, Healthy at Home, the Harbor Care Health and Wellness Center, and the Southern NH HIV/AIDS Task Force. Harbor Care has 325 employees, serves 5,000 patients/clients and has an annual budget of approximately 40 million dollars. We offer many programs specifically focused on our Military Veteran and homeless populations. Harbor Care integrates stable housing with vital supports such as: medical, dental, and mental health care, substance misuse treatment, employment services, and other wraparound supports proven to end homelessness, help change and save lives.
Our Mission:
Our mission is to provide vital services, including housing and healthcare to all in our communities needing assistance.
Our Vision:
Our vision is one where everyone gets to live safe, stable, and healthy lives, filled with purpose, respect, and dignity.
Benefits:
At Harbor Care, we consider our employees to be our greatest assets. We show this appreciation with our comprehensive benefit packages which include: Medical and Dental with a generous Employer Paid Portion. We also offer Voluntary Benefits such as Vision, Life Insurance, 401(k) with a competitive company paid match, and more. To promote a healthy lifestyle and living a well-balanced life, our employees are further benefited with a considerate time off policy and holiday schedule. In addition, employees can participate in our Employee Assistance Program to help support them and their families to handle life's challenges.
Federally Qualified Health Centers (FQHCs):
As Harbor Care transitions under the FQHCs umbrella, our Clinicians will have the opportunity to participate in the wonderful Student Loan Repayment Program called the National Health Services Corps (NHSC). This is one of the many great benefits of working at Harbor Care. For more information about this Program, please cut and paste the link below into your browser.
https://nhsc.hrsa.gov/loan-repayment/nhsc-loan-repayment-program.html
Job Summary:
The Prior Authorization Coordinator will collaborate with the Harbor Care and outside pharmacy's, Harbor Care providers, clinic staff, clients, commercial payers and other outside entities to coordinate care. The PA is responsible for obtaining prior authorizations and/or referrals for procedures and medications, scheduling appointments for outpatient testing with other providers, and/or entities and collaborate with commercial payers.
Requirements
Basic Qualifications:

• High School Diploma or GED
• Knowledge of Microsoft Office and Centricity EMR software preferred.
• Experience in a community healthcare setting.
• 2 years of medical prior authorization preferred.
• 2 years' experience in a medical related field required.

Preferred Qualifications :

• Associate or bachelor's degree is desired but not required.
• Resourcefulness, flexibility and integrity.
• Experience working in a healthcare organization is a plus.

Essential Duties and Responsibilities:

• Review chart documentation to ensure client meets medical policy guidelines.
• Prioritize incoming authorization requests according to urgency.
• Obtain authorization via payer website or by phone and follow up regularly on pending case.
• Initiate appeals for denied authorizations.
• Confirm accuracy of CPT and ICD-10 diagnosis in the procedure order.
• Records information in the Electronic Medical Record (EMR).
• Contacts clients to discuss authorization status.
• Knowledgeable regarding client population management and effective communicators for all segments of the patient population, particularly vulnerable populations.
• Other duties as assigned by management.

Knowledge and Skills:

• Knowledge of procedure authorization and its direct impact on the practice's revenue cycle.
• Understanding of payer medical policy guidelines while utilizing these guidelines to manage authorizations effectively.
• Basic understanding of human anatomy, specifically musculoskeletal.
• Proficient use of CPT and ICD-10 codes.
• Excellent computer skills including Excel, Word and Internet use.
• Detail oriented with organizational skills.
• Plans and prioritizes to meet deadlines.
• Excellent customer service skills; communicates clearly and effectively.
• Ability to multitask and remain focused while managing a high-volume, time sensitive.
• Anticipates and responds to the needs of others; assist others in a courteous, quick manner; treats others with care and respect maintaining privacy, confidentiality and dignity.
• Maintain a neat, clean and professional appearance (Dress Code Policy).
• Appropriate footwear for all seasons (Dress Code Policy).
• Conduct oneself in a manner that promotes safety.

Harbor Care's Commitment:
Model and enforce the "Red Carpet Treatment" among staff and clients comprised of the following:

• Earn our clients' trust.
• Build long-term relationships.
• Give Clients the best possible experience to make them feel like they're coming to a place they belong.
• Provide the best quality of service.
• Treat every Client with dignity and respect with each encounter.
• You will prioritize communication from any Harbor Care employee seeking help for a client.

Harbor Care is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws.