Prior Authorization Coordinator Job at Western Sierra Medical Clinic - Grass Valley Site
Western Sierra Medical Clinic - Grass Valley Site Grass Valley, CA 95945
JOB TITLE: Prior Authorization Coordinator
LOCATION: Grass Valley
GENERAL STATEMENT OF DUTIES:
Completes all patient prior authorizations for diagnostic imaging and medications. Responsible for performing a closed loop prior authorization system and closing out prior authorizations within 2 months of initial order, thus providing optimal customer service.
GENERAL DUTIES: (This list may not include all of the duties assigned.)
- Process and complete all prior authorizations for diagnostic imaging and medications for WSMC patients following a closed loop system workflow.
- Maintain ongoing electronic tracking and appropriate documentation on prior authorizations to promote team awareness and ensure patient safety.
- Ensure complete and accurate registration, including patient demographic and current insurance information.
- Assemble information concerning patient's clinical background and prior authorization needs. Per prior authorization guidelines, provide appropriate clinical information to health insurance.
- Contact insurance companies to ensure prior approval requirements are met. Present necessary medical information such as history, diagnosis and prognosis.
- Review details and expectations about the prior authorizations with patients.
- Assist patients in problem solving potential issues related to the health care system, or social barriers (e.g., request interpreters as appropriate, or transportation services assistance).
- Be the system navigator and point of contact for patients and families, with patients and families having direct access for asking questions and raising concerns regarding prior authorization(s) for diagnostic imaging and medications. May assume advocate role on the patient's behalf with the insurance carrier to ensure approval of the necessary supplies/services for the patient in a timely fashion.
- Establish and maintain relationships with identified service providers.
- Ensure that prior authorizations are addressed in a timely manner, as established in current documented workflows.
- Perform a closed loop communication process to update patient of status of prior authorization at every interval of process via patient portal or telephone.
- Ensure that patient's primary care chart is up to date with information on prior authorization(s).
- Respond to faxed requests for information in regards to prior authorization(s).
- Tracking of prior authorization data to assist in improving prescribing habits, thus reducing prior authorizations.
- Provide drug formulary updates to supervisor to decrease medication prior authorizations.
- Maintains information in a confidential manner.
- Documents all pertinent information in patient’s electronic medical record according to WSMC’s policies and procedures.
- Upholds WSMC’s policies and Procedures, infection control standards, applicable state, federal and local laws.
- Quality Improvement Duties:
- Participates in quality improvement activities;
- Participates as assigned in interdepartmental quality improvement team efforts; and
- Contributes to overall Community Health Center efforts in quality improvement towards higher-quality, more cost-effective health care for patients and improved quality of work-life for staff members.
- Other duties as assigned.
Minimum Education and skills needed:
1. High School Diploma or GED
2. Two years of clinical experience
3. One year of Medical Assistant experience
4. Strong customer service focus
5. Teamwork orientation
6. Effective verbal and written communication skills
7. Organized and able to manage competing priorities
Preferred Education and skill (not required):
1. One year of medical front-office training preferred.
2. Familiarity with an electronic practice management system.
3. Computer literate (i.e. logging on to computer, usage of keyboard and mouse, familiarity with Windows, Microsoft Word and Microsoft Excel).
4. Ability to type 40 wpm.
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