Prior Authorization & DME Coordinator

PRIMARY RESPONSIBILITIES:

1. Ensures the provision of high-quality care by completing prior authorization (PA) and durable medical equipment (DME) requests. 

• Works closely with primary care team to ensure timely response to PA and DME requests.
• Effectively utilize the EHR and online authorization sites for medication programs i.e. CoverMyMeds.
• Copy, fax, and mail documents and information as requested by insurance carriers and DME supply companies.
• Uphold patient, team member, and employer confidentiality. Comply with HIPAA regulations.
• Maintain up to date insurance medication formulary information.

1. Manages communication with patients and primary care team regarding approval process and outcome of PA/DME requests.

• Communicate clearly in person, on the phone, and in writing to establish/maintain cooperative relationships with patients, families, and clinical staff.
• Maintain follow up system for reporting PA/DME outcomes to primary care time and patients in a timely manner.
• Document progress and outcomes of PA/DME requests clearly in patient medical record via EHR.

1. Provide cross coverage as appropriate. 

• Completes and faxes forms including but not limited to school physical, school and work excuse letters, and other state forms.
• Assists with medication refills under the direction and supervision of the prescribing provider.
• Assist with scheduling appointments for follow up care as needed.
• Coordinates care as directed via phone, patient portal, and/or letters as needed.
• Responds to tasks from team members in a timely manner.

1. Attends and actively participates in health center medical team meetings and other staff meetings as required.

1. Effectively communicates with staff across departments as needed. 

REQUIRED SKILLS, EDUCATION & EXPERIENCE:

Education:       High School diploma or equivalent is required.

Equivalent experience or Associate Degree in Medical Assisting, certificate from an accredited medical assisting program such as CMA or CCMA, a RMA License, CPhT, or LPN is required.  

Proficiency in written and spoken English. Bi-lingual English/Spanish, English/Moldovan, or English/Russian is a plus.

Experience:     1-3 years’ experience in a medical office setting using an electronic health record is required.

Skills:  

• Familiarity with Electronic Health Record systems is required, familiarity with Epic is preferred.
• Must be exceptionally organized, detail oriented, and patient.
• Must be able to work harmoniously with ethnically, culturally, racially, and gender diverse staff and patients.  
• The ability to efficiently operate basic office equipment (multi-line phone, fax, photocopier) is required.
• The ability to use Microsoft Office Suite (Word, Excel, and Outlook) and Internet is required.
• Must understand and be familiar with basic medical terminology.

PHYSICAL DEMANDS:  

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.  While performing the duties of this job, the employee is required to stand, walk, sit, use the hands to finger, handle or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear; taste or smell.  Must be able to lift and/or move up to 25 pounds.  Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus.

WORKING CONDITIONS: 

While performing the required duties of this job, the employee is exposed to weather conditions prevalent when traveling between Health Center locations where medical care is provided.  This position performs tasks that involve exposure to blood, body fluids or tissues.

This job description is subject to review in the light of changing circumstances and is not intended to be rigid and inflexible but should be regarded as providing guidelines within which the employee works. Performs other duties as assigned.

Prior Authorization and DME Coordinator.docx