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Prior Authorization Coordinator

2 months ago

Hawthorne, United States Boston Childrens Health Physicians LLP Full time

**COVID vaccine will be required unless medical / religious exemption.** Seeking a Prior Authorization Coordinator for BCHP's Pediatric Office in Hawthorne, NY. Pay rate approx. $23/hr-$26/hr, negotiable based on experience.

**Duties**
- Create and or maintain ongoing tracking system
- Remain up to date on healthcare authorization process
- Answer calls related to authorizations from Providers ,pharmacies ,parents,and affiliates.
- Communicate effectively and interact with the provider group and health plans daily or as indicated regarding referral authorization issues
- Data entry
- Process requests that are approved, denied or deferred and bring them to resolution
- Deferred authorization maintenance, tracking, and follow up
- Checks eligibility and benefits on all authorizations prior to processing PAs
- Returns phone calls to customers and follows up with requests
- Maintain patient confidentiality so that HIPAA compliance is observed at all times
- Assists other staff and supports the team approach
- Communicate appropriately and clearly to management, co-workers, and physicians
- Other Duties as assigned

**Responsibilities**:

- Individual will work with the providers and insurance companies to obtain the necessary pre
- Certifications, authorizations and referrals for services ordered
- Obtain clinical information (Medical History, diagnosis and any relevant laboratory reports) necessary to complete the prior-authorization
- Review the medical records, diagnosis and laboratory report
- Work with insurance plan to pre-certify/authorize medication
- Ensures insurance carrier documentation requirements are met and authorization/referral documentation is scanned and documented in the patient’s medical record
- Reviews and submits all follow-up authorizations, re-certifications and referrals
- Appeals denials and/or set-up peer to peer reviews
- Has knowledge of online authorization sites as well handling them via phone
- Ability to work independently as well as part of a team with flexibility and willingness to learn and take initiative on variety of tasks and projects

**Qualifications**:

- Pediatric Prior Authorization experience preferred
- Ability to prioritize and multitask, excellent written and verbal communication skills, strong attention to detail, strong organizational skills.

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