Children's Health
Medication Prior Authorization Coordinator
Children's Health, Dallas, Texas, United States, 75215
Medication Prior Authorization Coordinator
Children's Health
Job Title & Specialty Area: Medication Prior Authorization Coordinator
Department: Utilization Management
Location: Trinity Tower Dallas
Shift: Day, Mon - Fri
Job Type: This position is remote, but does require attendance on site as needed
Why Children’s Health? At Children's Health, our mission is to Make Life Better for Children, and we recognize that their health plays a crucial role in achieving this goal.
Through our cutting‑edge treatments and affiliation with UT Southwestern, we strive to deliver an extraordinary patient and family experience, ensuring that every moment, big or small, contributes to their overall well‑being.
Our dedication to promoting children's health extends beyond our organization and encompasses the broader community. Together, we can make a significant difference in the lives of children and contribute to a brighter and healthier future for all.
Summary Responsible for the provision of complex activities surrounding obtaining appropriate medication authorizations from payors. Utilizing appropriate workflow to assure zero authorization errors, efficient operations, and creating expeditious reimbursement opportunities and optimal customer satisfaction.
Responsibilities
Clerical functions include but are not limited to the management of phone lines, faxing, documentation of information received by phone or fax, retrieval of medical records, scanning of documents and other clerical functions not listed.
Collect insurance benefit information from insurance representative or web portal to make determination of patient's insurance benefits and coverage options.
Enter data into EHR in an accurate manner that assures resolution to patient claims when processed.
Performs routine medication authorization processes, including coverage eligibility, insurance verification, and authorization requirements, resolving any issues with coverage and escalates complicated issues according to supervisor/manager.
Demonstrates the components of the Children's Health System Vision, Mission and The Children's Way Values.
Possesses the ability to interpret and demonstrates compliance with performance standards, regulations and policies and procedures and third-party contracts, guidelines.
Participates in team-oriented process improvement initiatives for the department and organization.
Follows all safety rules while on the job, reports accidents promptly and corrects minor safety hazards.
Continually communicate with and advocate for patients and families, Providers, multidisciplinary team members and payers to facilitate coordination of submissions and approvals.
Punctual notification to physicians, clinical staff and customers regarding additional requested information from payor regarding medications authorizations to reduce approval delays.
Work collaboratively with others to define and study areas of inefficiency and participate in process improvement projects.
Demonstrate understanding of departmental metrics and key performance indicators used to measure work performance and departmental effectiveness in reached desired results.
Stays abreast of payor guidelines and standards.
Proactively seeks to understand areas/roles outside of immediate area/role within department.
Performs all other duties as assigned.
Work Experience
At least 2 years customer service experience with two years of healthcare experience including insurance verification and/or billing required.
Education
Two-year Associate's degree or equivalent experience required.
Licenses and Certifications
National Association of Healthcare Access Management CHAA Certification preferred.
Healthcare Financial Management Association CRCR Certification preferred.
Job Profile
Is skilled in a range of processes, procedures and systems to carry out assigned tasks or has developed deep skills in a single area.
Understands the roles of all immediate team members and has a good understanding of how own team integrates with others.
Regularly provides guidance and support to more junior team members on challenging problems; helps them balance their workload and apply their skills.
Provides solutions to problems in situations that are atypical or occur infrequently based on practice and existing precedents.
Impacts the quality, timeliness and effectiveness of the team.
Uses discretion to modify work practices and processes (but not policies or procedures) to achieve results or improve efficiency.
Clearly and accurately conveys complex information.
Non-Management Skills
Maintain effectiveness when experiencing major changes in work responsibilities or environment; adjust effectively to work within new work structures, processes, requirements, or cultures.
Use appropriate interpersonal styles to establish effective relationships with customers and internal partners; interact with others in a way that promotes openness and trust and gives them confidence in one's intentions.
Ensure that the customer perspective is a driving force behind business decisions and activities; craft and implement service practices that meet customers' and own organization's needs.
Develop and use collaborative relationships to facilitate the accomplishment of work goals.
Take prompt action to accomplish objectives; take action to achieve goals beyond what is required; be proactive.
Deal effectively with others in an antagonistic situation; use appropriate interpersonal styles and methods to reduce tension or conflict between two or more people.
Effectively manage one's time and resources to ensure that work is completed efficiently.
Accomplish tasks by considering all areas involved, no matter how small; showing concern for all aspects of the job; accurately checking processes and tasks; being watchful over a period of time.
Assimilate and apply new job-related information in a timely manner.
A Place Where You Belong We put our people first. We welcome, value, and respect the beliefs, identities and experiences of our patients and colleagues. We are committed to delivering culturally effective care, creating meaningful partnerships in the communities we serve, and equipping and developing our team members to make Children’s Health a place where everyone can contribute.
Holistic Benefits – How We’ll Care For You
Employee portion of medical plan premiums are covered after 3 years.
4%-10% employee savings plan match based on tenure.
Paid Parental Leave (up to 12 weeks).
Caregiver Leave.
Adoption and surrogacy reimbursement.
As an equal opportunity employer, Children's Health does not discriminate against employees or applicants because of race, color, religion, sex, gender identity and expression, sexual orientation, age, national origin, veteran or military status, disability, or genetic information or any other Federal or State legally-protected status or class. This applies to all aspects of the employer-employee relationship including but not limited to recruitment, hiring, promotion, transfer pay, training, discipline, workforce adjustments, termination, employee benefits, and any other employment-related activity.
Seniority level: Entry level
Employment type: Full-time
Job function: Other
Industry: Hospitals and Health Care
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Job Title & Specialty Area: Medication Prior Authorization Coordinator
Department: Utilization Management
Location: Trinity Tower Dallas
Shift: Day, Mon - Fri
Job Type: This position is remote, but does require attendance on site as needed
Why Children’s Health? At Children's Health, our mission is to Make Life Better for Children, and we recognize that their health plays a crucial role in achieving this goal.
Through our cutting‑edge treatments and affiliation with UT Southwestern, we strive to deliver an extraordinary patient and family experience, ensuring that every moment, big or small, contributes to their overall well‑being.
Our dedication to promoting children's health extends beyond our organization and encompasses the broader community. Together, we can make a significant difference in the lives of children and contribute to a brighter and healthier future for all.
Summary Responsible for the provision of complex activities surrounding obtaining appropriate medication authorizations from payors. Utilizing appropriate workflow to assure zero authorization errors, efficient operations, and creating expeditious reimbursement opportunities and optimal customer satisfaction.
Responsibilities
Clerical functions include but are not limited to the management of phone lines, faxing, documentation of information received by phone or fax, retrieval of medical records, scanning of documents and other clerical functions not listed.
Collect insurance benefit information from insurance representative or web portal to make determination of patient's insurance benefits and coverage options.
Enter data into EHR in an accurate manner that assures resolution to patient claims when processed.
Performs routine medication authorization processes, including coverage eligibility, insurance verification, and authorization requirements, resolving any issues with coverage and escalates complicated issues according to supervisor/manager.
Demonstrates the components of the Children's Health System Vision, Mission and The Children's Way Values.
Possesses the ability to interpret and demonstrates compliance with performance standards, regulations and policies and procedures and third-party contracts, guidelines.
Participates in team-oriented process improvement initiatives for the department and organization.
Follows all safety rules while on the job, reports accidents promptly and corrects minor safety hazards.
Continually communicate with and advocate for patients and families, Providers, multidisciplinary team members and payers to facilitate coordination of submissions and approvals.
Punctual notification to physicians, clinical staff and customers regarding additional requested information from payor regarding medications authorizations to reduce approval delays.
Work collaboratively with others to define and study areas of inefficiency and participate in process improvement projects.
Demonstrate understanding of departmental metrics and key performance indicators used to measure work performance and departmental effectiveness in reached desired results.
Stays abreast of payor guidelines and standards.
Proactively seeks to understand areas/roles outside of immediate area/role within department.
Performs all other duties as assigned.
Work Experience
At least 2 years customer service experience with two years of healthcare experience including insurance verification and/or billing required.
Education
Two-year Associate's degree or equivalent experience required.
Licenses and Certifications
National Association of Healthcare Access Management CHAA Certification preferred.
Healthcare Financial Management Association CRCR Certification preferred.
Job Profile
Is skilled in a range of processes, procedures and systems to carry out assigned tasks or has developed deep skills in a single area.
Understands the roles of all immediate team members and has a good understanding of how own team integrates with others.
Regularly provides guidance and support to more junior team members on challenging problems; helps them balance their workload and apply their skills.
Provides solutions to problems in situations that are atypical or occur infrequently based on practice and existing precedents.
Impacts the quality, timeliness and effectiveness of the team.
Uses discretion to modify work practices and processes (but not policies or procedures) to achieve results or improve efficiency.
Clearly and accurately conveys complex information.
Non-Management Skills
Maintain effectiveness when experiencing major changes in work responsibilities or environment; adjust effectively to work within new work structures, processes, requirements, or cultures.
Use appropriate interpersonal styles to establish effective relationships with customers and internal partners; interact with others in a way that promotes openness and trust and gives them confidence in one's intentions.
Ensure that the customer perspective is a driving force behind business decisions and activities; craft and implement service practices that meet customers' and own organization's needs.
Develop and use collaborative relationships to facilitate the accomplishment of work goals.
Take prompt action to accomplish objectives; take action to achieve goals beyond what is required; be proactive.
Deal effectively with others in an antagonistic situation; use appropriate interpersonal styles and methods to reduce tension or conflict between two or more people.
Effectively manage one's time and resources to ensure that work is completed efficiently.
Accomplish tasks by considering all areas involved, no matter how small; showing concern for all aspects of the job; accurately checking processes and tasks; being watchful over a period of time.
Assimilate and apply new job-related information in a timely manner.
A Place Where You Belong We put our people first. We welcome, value, and respect the beliefs, identities and experiences of our patients and colleagues. We are committed to delivering culturally effective care, creating meaningful partnerships in the communities we serve, and equipping and developing our team members to make Children’s Health a place where everyone can contribute.
Holistic Benefits – How We’ll Care For You
Employee portion of medical plan premiums are covered after 3 years.
4%-10% employee savings plan match based on tenure.
Paid Parental Leave (up to 12 weeks).
Caregiver Leave.
Adoption and surrogacy reimbursement.
As an equal opportunity employer, Children's Health does not discriminate against employees or applicants because of race, color, religion, sex, gender identity and expression, sexual orientation, age, national origin, veteran or military status, disability, or genetic information or any other Federal or State legally-protected status or class. This applies to all aspects of the employer-employee relationship including but not limited to recruitment, hiring, promotion, transfer pay, training, discipline, workforce adjustments, termination, employee benefits, and any other employment-related activity.
Seniority level: Entry level
Employment type: Full-time
Job function: Other
Industry: Hospitals and Health Care
#J-18808-Ljbffr