Job Description
This position can be based in the following locations: Boston, Waltham, Needham, Weymouth, Peabody.
Position Summary:
Coordinates and facilitates administrative processes and services at a center or program necessary to deliver and support care for patients Supports the prior authorization process and scheduling for general providers and/or may train on more complex prior authorization processes, support more complex patients with specialized medications and treatments in support of patients with chronic diseases. Coordinates communications and services with insurance companies as directed. May assist with coordinating services with medical device and supply companies, and specialty pharmacy companies in support of providers’ care.
Key Responsibilities:
Patient Encounter:
- Answers, screens and routes a high volume of phone and email inquiries from patients and families and external companies in coordination of clinical services. Records and forwards messages and triages calls to nurses, physicians and numerous other providers for urgent information or services. Initiates calls for emergency services as required.
- Responds to patient’s concerns and needs within scope of knowledge and authority and in accordance with our best practices and procedures. Responds to situations requiring escalated service response, ensuring the appropriate providers and parties across multiple specialty areas are made aware of concerns and follows up to ensure resolution.
- Schedules patient encounters and procedures to coordinate within and across providers in multiple specialties. Obtains and records required authorizations for prescription medication with insurance providers. Verifies patient demographics. Collects all necessary clinical documentation and information.
- Collects and organizes medical records, information, materials and supplies required for admissions or encounters. Prepares requisitions and other standard forms as requested by clinician or supervisor. Communicates with other departments to coordinate ancillary clinical/administrative services. Prepares, routes and tracks routine administrative forms and documents.
- Manages the prior authorization process for patients of general providers and/or may train on more complex prior authorization processes in support of multiple specialties. Prepares letters of medical necessity based on physician’s notes.
- Coordinates appeals with clinicians and patient families by preparing letters of appeal or connecting the clinician directly with the insurance company.
- May serve as point of contact on the process for obtaining and responding to additional requests for prior authorizations for medicines across relevant insurance companies for supported clinical area.
- Actively participates in and contributes to departmental and organizational initiatives and projects with a focus on continuous process improvement.
- Recommends and assists in implementing change in internal systems and procedures
Minimum Qualifications
Education:
- High School / GED required.
- Some college or occupationally specific education/training preferred.
- Minimum of 1 year of experience in a high volume administrative role with an emphasis on problem resolution among multiple internal and/or external parties
- Ability to learn the prior authorization process for medicines sufficient to navigate the intricacies of the current processes and facilitate improvements
- Strong organizational skills and attention to detail
- An ability to work with diverse internal and external constituencies
- A sense of urgency and an ability to understand priorities and anticipate needs while also being flexible in order to accommodate changes in priorities
Numbers & Facts
| Location | Boston, MA |
Skills
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