Prior Authorization Coordinator
2 weeks ago
The role of the Prior Auth Coordinator is to promptly, efficiently and accurately execute all aspects of the referral process. Facilitating the right care at the right time in the right setting. Process requests from Access Express that are pended or reprocess approved or denied authorizations and package properly for review and resolution. Check eligibility and benefits on all DME and home health authorizations prior to forwarding on request to prior authorization nurse or medical director for approval. Capture any leakage and provide feedback to the leadership team for additional training. Maintain turnaround time compliance in all aspects of the Prior Authorization process. Promote the quality and cost effectiveness of medical care through strict adherence to all UM Policy and procedure.
Essential Duties and Responsibilities include the following:
- Understand and execute the principles of Prior Authorization to facilitate the right care at the right time in the right setting.
- Perform all assistant and coordinator job functions.
- Able to solve complex prior authorization questions and issues.
- Effectively handle all incoming provider calls including the most challenging provider offices.
- Identified trends with provider offices and interfaces with those provider offices.
- Request Network Management training or on site visit to provider offices needing reinforcement.
- Identify issues that need to be escalated to a lead or supervisor.
- Identify opportunities for improvement and make recommendations for change.
- Process requests from Access Express that are pended or reprocess approved or denied auths and package properly for review and resolution.
- Check eligibility and benefits on all items requiring a benefit check such as DME and home health authorizations prior to forwarding on request to prior authorization nurse or medical director for approval.
- Capture any leakage and provide feedback to the leadership team for additional training.
- Maintain turnaround time compliance in all aspects of the Prior Authorization process.
- Work in collaboration with the department Prior Auth Assistants, Specialists, Team Leads, Supervisor, Managers and Regional Medical Directors and Network Managers to ensure a level of referral processing that meets or exceeds the organization's expectation.
- Recognize when an error has been made and immediately report it to the appropriate supervisor or manager.
- Maintain quality monitors as assigned by Supervisor.
- Complete assigned tasks accurately and within specified time limits.
- Treat co-workers and customers with patience and respect.
- Assist other staff and support the team approach.
- Participate in the efficient, effective, and responsible use of resources such as supplies and equipment.
- Communicate appropriately and clearly to management, co-workers, and physicians.
- Maintain all reference material that is provided by the supervisor, manager or director.
- Know and follow the Employee Handbook policies and procedures.
- Maintain patient confidentiality so that HIPAA compliance is observed at all times.
- Demonstrate honesty and integrity in everyday activities.
- Arrive to work on time. Consistently be at work. Display flexibility regarding lunches, breaks and work hours.
- Willingness to work overtime when requested.
- All other duties as directed by Management.
The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.
Details of participation in these benefit plans will be provided if an employee receives an offer of employment.
If hired, employee will be in an "at-will position" and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.
As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare & Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment. Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees. We want to see you excel, because we believe that your success is our success.
Education and / or Experience:
- High School graduate required; Associates in Arts degree preferred.
- Ability to operate PC based software programs or data base management systems
- Knowledge of computers, faxes, printers and all other equipment.
- Proficient in MS Office programs (i.e. Word, Excel, Outlook, Access and PowerPoint).
- 1-2 years IPA or Medical office experience
- Experience with prior authorization process strongly preferred.
- Knowledge of Healthcare and Managed Care preferred.
- Typing 60 words per minute with accuracy.
- Must possess strong organizational skills and be detail oriented.
- Ability to multi-task and meet turnaround times
- Proficient with turnaround time compliance in all aspects of the PA Process
- Ability to deal with responsibility with confidential matters.
- Ability to work in a multi-task, high energy environment.
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