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Prior Authorization Coordinator

3 months ago

Louisville, United States Family Allergy & Asthma Full time
Job DescriptionJob DescriptionDescription:

Position Summary

The Prior Authorization Coordinator is responsible for demonstrating knowledge and application of job duties and functions under the direction of their manager(s) and/or Director(s); respectfully interacts with all levels of staff; participates in department activities; promotes independence; adherence to the attendance policy; encourages socialization; advocates for the quality of life of our patients while maintaining compliance with all applicable laws, regulatory and organizational standards; supports the company’s core values.


Summary of Duties and Responsibilities

· Work directly with Healix and specialty pharmacies to coordinate the processes and procedures for tracking inventory, shipping, and reutilizing inventory for all specialty medications across the practice.

· Works closely with the biologic/specialty medication specialist nurse to help streamline the process’.

· Communicates with providers, nurses, managers, and patients to track specialty medications and biologics given or received.

· Communicates on the telephone professionally and pleasantly. Efficiently screens and directs calls and make appointments as necessary for the biologics and specialty medication process, if required

· Runs reports to track appointments/biologics inventory and maintains integrity of patient charts.

· Collecting all necessary documentation to complete timely and accurate submission of prior authorizations for biologics and specialty medications, as necessary.

· Interacts with clients, insurance companies, sales representatives, providers, and patients, as necessary.

· Prepare all necessary shipping documentations, supplies and items to be shipped or couriered across the practice.

· Work with our vial production group to ensure all items, medications, vials, and supplies are shipped/couriered to all offices accurately and in a timely manner.

· Ensure all items received from outer locations are unpacked and placed in correct locations upon arrival.

· Maintain and follow HIPAA policies and procedures.

· Other relevant duties as assigned.

Requirements:

Abilities, Knowledge and Skills

Effective communication skills to include:

1. Ability to fluently speak and read English

2. Ability to read and interpret documents such as safety rules, handbooks, policies, patient care plans and procedure manuals

3. Ability to communicate effectively, verbally and written, with all levels of staff and patients


Education, Prior Work Experience, Special Skill And Knowledge Requirements

· High school diploma/ GED

· Certified Medical Assistant preferred

· Previous experience with Biologics/Prior Authorizations preferred

· Previous medical office experience preferred

· Knowledge of medical terminology

· Ability to work independently

· Proficient and accurate with word processing (Word), spreadsheets (Excel), charting, flowcharting, and computers in general

· EMR experience preferred

· Attention to detail is essential

· Ability to perform multiple tasks simultaneously with accuracy and efficiency while maintaining composure.

· Strong written and verbal communication skills.

· CPR certification required

· Valid Driver’s License required

· Must be at least 18 years of age


Physical Demands and Work Environment

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 physical demands.

1. While performing the duties of this job, the employee is regularly required to use hands to handle, or feel objects, tools, or controls; reach with hands and arms; and talk or hear.

2. The employee frequently is required to stand, walk, stoop, kneel, crouch, reach, push, pull, bend and sit. On average, injection room or clinic staff may be standing or walking 80% of their shift.

3. The employee must occasionally lift and/or move up to 30 pounds.

4. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception, and the ability to adjust focus.

5. Specific communication abilities required by this job include the ability to talk and hear in order to converse with others, discern, convey, express oneself, and exchange information.


Work Environment

The work environment characteristics described here are representative of those an employee may encounter while performing the essential functions of this job.

1. The noise level in the work environment is usually moderate; lighting is in the standard range.

2. The employee is subject to infectious waste, potential exposure to allergens in concentrated forms, diseases and conditions.


EEOC Compliance

Family Allergy & Asthma provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.