Medication Prior Authorization Coordinator

Job Title & Specialty Area: Medication Prior Authorization Coordinator Department: Utilization Management Location: Children's Health Dallas Shift: Full time: Monday Through Friday 8:30a to 5:00p Job Type: Remote but will be required to work the 2nd and 4th Thursday of each month onsite. 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. (i.e. Peer to Peer, letter of medical necessity, document signatures). 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. How You’ll Be Successful: 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 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. #J-18808-Ljbffr Children's Health