Authorization Specialist-Medications I

4 months ago

Ann Arbor, United States Trinity Health Full time
POSITION DESCRIPTION:

Responsible for reviewing, submitting, monitoring and responding to issues regarding medication prior authorizations for IHA patients. Reviews patient medical history to identify supporting documentation in the patient chart relevant to the medication; contacts insurance companies and obtains authorization for medication.

ESSENTIAL JOB FUNCTIONS:
  1. Reviews patient medical history to identify supporting documentation in the patient chart relevant to the medication.
  2. Responsible for reviewing, submitting, monitoring and responding to issues regarding medication prior authorizations for IHA patients.
  3. Professionally communicates with the ordering provider, practice support staff and representatives of insurance companies, including oral and written communication.
  4. Contacts insurance companies via appropriate methods and obtains medication authorizations.
  5. Updates information in patient medical record in EPIC (EMR) with approval or declination information; follows up with ordering physician as to status and/or issues with prior authorizations.
  6. Efficiently tracks pending authorizations for multiple offices.
  7. Monitors in basket, email and fax server if applicable. Follows up on correspondence timely and accurately.
  8. Participates in data collection and data review assignments as required.
  9. Supports other offices, attends required meetings and training and participates in committees as requested.
  10. Performs other duties as assigned by Call Center leadership.
ORGANIZATIONAL EXPECTATIONS:
  1. Creates a positive, professional, service-oriented work environment for staff, patients and family members by supporting the mission and values of both IHA and Trinity Health.
  2. Must be able to work effectively as a member of the clinical care team.
  3. Assumes responsibility for performance of job duties in the safest possible manner, to assure personal safety and that of coworkers, and to report all preventable hazards and unsafe practices immediately to management.
  4. Successfully completes IHA's "The Customer" training and adheres to IHA's standard of promptly providing a high level of service and respect to internal or external customers.
  5. Maintains knowledge of and complies with IHA standards, policies and procedures.
  6. Maintains complete knowledge of office services and in the use of all relevant office equipment, computer and manual systems.
  7. Maintains strict patient and employee confidentiality in compliance with IHA and HIPAA guidelines.
  8. Serves as a role model by demonstrating exceptional ability and willingness to take on new and additional responsibilities. Embraces new ideas and respects cultural differences.
  9. Uses resources efficiently.
  10. If applicable, responsible for ongoing professional development - maintains appropriate licensure and continuing education credentials, participates in available learning opportunities.
MEASURED BY:

Performance that meets or exceeds IHA CARES Values expectation as outlined in IHA Performance Review document, relative to position.

ESSENTIAL QUALIFICATIONS:

EDUCATION: High School Diploma

CREDENTIALS/LICENSURE: Prior Authorization Certified Specialist (PACS) certification recommended

MINIMUM EXPERIENCE: 1- 3 years' previous related experience in pharmacy or equivalent medical setting and/or prior authorization experience. Knowledgeable in Microsoft 365 (especially Excel) preferred. CNAs welcome to apply.

POSITION REQUIREMENTS (ABILITIES & SKILLS):
  1. Proficient/knowledgeable in medical terminology.
  2. Proficient knowledge of major health plans and insurance processes.
  3. Ability to successfully process medication authorizations for up to 4 offices, typically in the same division.
  4. Proficiency in operating a standard desktop and Windows-based computer system, including but not limited to, electronic medical records (EMR), EPIC and CoverMyMeds, email, e-learning, intranet and computer navigation. Knowledgeable in Microsoft 365 (especially Excel) preferred. Ability to use other software as required while performing the essential functions of the job.
  5. Excellent communication skills in both written and verbal forms, including proper phone etiquette. Ability to read, understand and respond to detailed written and oral instructions.
  6. Ability to communicate with insurance companies, both written and verbally.
  7. Ability to effectively work with and communicate with various levels of organizational members and diverse populations including IHA staff, providers, patients, vendors, family members, outside customers and community groups.
  8. Ability to work collaboratively in a team-oriented environment; displays courteous and friendly demeanor.
  9. Ability to document steps, processes and procedures.
  10. Ability to cross-train in other areas of practice in order to achieve smooth flow of all operations.
  11. Good organizational and time management skills to effectively juggle multiple priorities, time constraints and ever-changing medical situations.
  12. Ability to exercise sound judgement and problem-solving skills.
  13. Ability to perform mathematical calculations needed during the course of performing basic job duties.
  14. Knowledge of the compliance aspects of clinical care and patient privacy and best practices in medical office operations.
  15. Ability to handle patient and organizational information in a confidential manner.
  16. Ability to travel to other office/practice sites and meeting and training locations.
  17. Successful completion of IHA competency-based program within introductory and training period.
MINIMUM PHYSICAL EXPECTATIONS:
  1. Physical activity that often requires keyboarding, phone work and charting.
  2. Physical activity that often requires time working on a computer.
  3. Physical activity that sometimes requires lifting up to 5 lbs.
  4. Physical activity that sometimes requires walking.
  5. Specific vision abilities required include close vision, depth perception, color vision, peripheral vision and the ability to adjust and focus.
  6. Manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment.
  7. Must hear and speak well enough to conduct business over the telephone or face to face for long periods of time in English.


MINIMUM ENVIRONMENTAL EXPECTATIONS:

This job operates in a typical office environment which involves frequent interruptions and significant interaction with people (some of whom are scared, hurt and/or ill) which can be stressful and result in competing priorities.

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