Care Coordinator- Prior Authorization

We will not be accepting any applications from the following areas: California, New York, Wyoming, Colorado, Minnesota, Michigan, New Jersey, Illinois, Massachusetts, Washington, Maryland, DC, Montana, Iowa, Pennsylvania, Oregon, Connecticut, South Dakota, Nevada, Alaska and Hawaii. ***Schedule is Monday- Friday 12-8pm EST Only*** We are seeking a Care Coordinator that specializes in back office responsibilities including but not limited to referral management, prior authorizations, specialty pharmacy infusions, and medical records to help deliver and implement clinical strategies and assist in member care coordination in collaboration with a multidisciplinary clinical team. As a core member of the clinical team, you will utilize a high level of attention to detail, organization, and communication skills to help obtain, manage, and follow up on member referrals and prior authorizations to ensure key care plan goals are met. A strong ability to manage multiple priorities, knowledge of CPT and ICD-10 codes and proficiency in navigating the prior authorization process will contribute to positive member outcomes of safe and highly efficient care delivery. You will have access to ongoing training and support from a GI focused team to help you develop an expertise with digestive health conditions. What you’ll do? Collaborate with a multidisciplinary team of care providers (including MDs, NPs, RDs, Behavioral Health Providers, and Health Coaches) to provide a whole-person approach to member care. Responsible for the coordination, tracking and communication of patient referrals, prior authorizations, and medical records to promote team awareness and patient safety Ensure comprehensive communication and expectations are explained to the member throughout the referral and authorization process Provide complete and accurate registration of referrals and authorizations including patient demographics, current insurance information and clinical documentation to external providers and specialty pharmacies Offer proficient knowledge of referrals, insurance requirements and the prior authorization process to internal and external resources, to eliminate barriers to care execution and provide follow up on progress toward meeting key goals. Prioritize incoming referral, medical record requests, and authorization requests according to urgency Apply knowledge of CPT and ICD-10 codes to obtain authorizations in a timely manner while demonstrating understanding of payer medical policy guidelines Initiate appeals for denied authorizations and maintain close follow up to ensure positive member outcomes Engage in external coordination of pharmacy support services to ensure members receive all necessary support services available throughout the prior authorization process Assist members in accessing services, providing personalized customized customer service and support while maintaining close communication with members of the care coordination team. Manage key reports and track relevant data to identify successes and drive refinements in operational processes. Openness and ability to cross-train in additional care coordination tasks and responsibilities to support full cycle member engagement Partner with the Clinical Operations leadership team to define and help iterate on strategies for member care coordination Who You Are? Minimum of 2-3 years experience working in a healthcare coordination, care or case management role, preferably in a digital healthcare environment. Must be able to work Monday through Friday 12pm - 8pm EST. Fluent in healthcare terminology or working understanding of clinical concepts. Background knowledge in navigating health insurance plans and coverage on the part of patients. Must be able to provide breakdown of benefits analysis to consumers. Ability to work in a cross-functional interdisciplinary modality and effectively create solutions for complicated patient concerns. Comfortable and competent with ... (truncated, view full listing at source)