Prior Authorization and Medical Records Coordinator- Outpatient Behavioral Health

Prior Authorization and Medical Records TriHealth Outpatient Behavioral Health*** Job Description The Prior Authorization and Medical Records Specialist is responsible for obtaining and managing insurance authorizations to support timely patient access to services within various Behavioral Health programs, including partial hospitalization (PHP), intensive outpatient program for addiction (IOP), neuropsychology, and psychiatric medication management practices. This role serves as a liaison between providers, patients, and insurance payers to ensure required authorizations are secured prior to treatment, testing, and medication services. The specialist reviews clinical documentation, submits authorization requests, tracks approval statuses, manages denials and appeals, and maintains accurate records within the electronic medical record. Success in this role requires strong organizational skills, attention to detail, knowledge of insurance requirements, and a commitment to supporting high-quality patient care through efficient and compliant authorization processes. We offer career growth opportunities , a comprehensive benefits package, and competitive pay based on level of education and experience. Location North – TriHealth Evendale Medical Office Building, 3147 Glendale Milford Rd, Cinti 45241 West – TriHealth Physician Partners, 6331 Glenway Avenue, Cinti 45211 Work Schedule Full-Time (80 hours bi-weekly) No Holidays! Incentives & Benefits In addition to a comprehensive benefits package—including medical, dental, vision, paid time off, retirement plans, and tuition reimbursement—this role offers competitive pay based on education level and experience. Please view our benefits page Job Requirements Graduate of an approved technical, professional, or vocational program in Healthcare; Healthcare clinical experience preferred physician practice or related field Equivalent experience accepted in lieu of degree Must be certified or registered medical assistant Must maintain this certification and registration status Registered Medical Assistant (RMA), through AMT, NCCT, or NHA, or certified Medical Assistant (CAN) by AAMA, and Cardiopulmonary Resuscitation (CPR) Medical office flow, especially the clerical/front office tasks Ability to make quick decisions based on well thought out consequences/results Knowledge of EMR, practice management software and medical coding/billing strongly encouraged Job Overview This position provides both direct patient care in a primary care office and works with care delivery providers to identify gaps in care, contacts patients to schedule required care, and provides referral follow up. The Medical Home Medical Assistant provides pre-visit planning for the practice's patient panel, coordinates messages through electronic portals, and assists in managing transitions of care. The Medical Home Medical Assistant will act as a clinical liaison to the physician care plan and actively communicate with patients. The MA participates in process improvements, is knowledgeable of clinical goals and outcomes including patient satisfaction and engagement. Other job-related duties may be assigned to meet the needs of the department. Must be certified or registered medical assistant and have strong skills in clinical care, customer service, communication, and teamwork. This role understands the needs of the organization and supports the mission, values, and management of TriHealth Physician Practices. Job Responsibilities Demonstrates proficiency in the rooming process for adult and/or pediatric primary care including: clinical procedures, immunizations, venipuncture, point of care testing, among others. Follows protocols and policies for scheduling, clinical procedures and appropriate use of medical equipment. Provides accurate/complete documentation of clinical calls and patient rooming info as well as order entry, pending prescriptions, noting current pharmacy, and enter edit workflows to result orders. Addresses patient messages (phone, mychart) in a timely manner and escalates patient issues as appropriate. Demonstrates clinical competency upon completion of orientation and annually. Maintains knowledge of population health, and embraces the philosophies of wellness, prevention and chronic disease management. Participates in tactics to close gaps in care. This includes pre-visit planning, participation in daily huddles, and informing physicians of any potential barriers to care identified. Has proficient understanding of the adult and/or pediatric preventative medicine schedule, which includes age-based wellness checks, appropriate vitals and labs, immunizations to administer, screening tools, and patient education to care for all patients we serve. Can identify and communicate with providers regarding patient wellness, chronic diseases, utilization, and care gaps. Attends continued education training and education such as Lunch and Learns and other opportunities. Participates in the longitudinal care continuum of patients. This includes collaborating with wrap-around services such as behavioral health, complex care nursing, social workers, community health workers, among others. Provides basic community resources to patients with social determinants of health. Supports and provides education and patient coaching of both wellness and chronic disease management.education and patient coaching of both wellness and chronic disease management. Other Job-Related Information Demonstrates knowledge in area of practice such as: Age related competencies and care of various populations. Understanding best practices in preventative care, chronic disease management and utilization across the continuum of health ("population health"). Working Conditions Climbing - Occasionally Concentrating - Consistently Hearing: Conversation - Frequently Interpersonal Communication - Consistently Kneeling - Occasionally Lifting Lifting 50+ Lbs - Occasionally Lifting 11-50 Lbs - Rarely Pulling - Occasionally Pushing - Occasionally Reaching - Consistently Reading - Consistently Sitting - Consistently Standing - Frequently Stooping - Occasionally Thinking/Reasoning - Consistently Use of Hands - Consistently Color Vision - Consistently Walking - Consistently TriHealth SERVE Standards and ALWAYS Behaviors At TriHealth, We Believe There Is No Responsibility More Important Than To SERVE Our Patients, Our Communities, And Our Fellow Team Members. To Achieve Our Vision And Mission, ALL TriHealth Team Members Are Expected To Demonstrate And Live The Following Serve: ALWAYS… Welcome everyone by making eye contact, greeting with a smile, and saying "hello" Acknowledge when patients/guests are lost and escort them to their destination or find someone who can assist Refrain from using cell phones for personal reasons in public spaces or patient care areas Excel: ALWAYS… Recognize and take personal responsibility to address and recover from service breakdowns when a customer's expectations have not been met Offer patients and guests priority when waiting (lines, elevators) Work on improving quality, safety, and service Respect: ALWAYS… Respect cultural and spiritual differences and honor individual preferences. Respect everyone’s opinion and contribution, regardless of title/role. Speak positively about my team members and other departments in front of patients and guests. Value: ALWAYS… Value the time of others by striving to be on time, prepared and actively participating. Pick up trash, ensuring the physical environment is clean and safe. Be a good steward of our resources, using supplies and equipment efficiently and effectively, and will look for ways to avoid waste. Engage: ALWAYS… Acknowledge wins and frequently thank team members and others for contributions. Show courtesy and compassion with customers, team members and the community #J-18808-Ljbffr TriHealth