When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.

　　Job Type:

　　Regular

　　Scheduled Hours:

　　40

　　Work Shift:

　　Day (United States of America)

　　The Prior Authorization Coordinator is responsible for coordinating comprehensive data elements, insurance verification, and clinical information for prescription pre-authorization management. Maintains knowledge of third party reimbursement regulations and medical terminology. Provides customer support and resolves problems that may arise as a result of customer inquiries. Assures continuity of care for patients receiving services through onsite pharmacies.

　　Job Description:

　　Essential Duties & Responsibilities including but not limited to:

　　1) Contacts insurance companies to determine eligibility and benefits for requested services

　　2) Drafts various correspondence letters and sends to insurers as necessary.

　　3) Provides information and answers to patient/caregiver questions and refers to clinician when appropriate or requested.

　　4) Follows up with the provider, patient, or insurance company if there are insurance coverage issues in order to obtain financial resolution

　　5) Obtains necessary clinical documentation from the requesting provider to use in the prior-authorization process, meet insurer contractual requirements (where applicable), and to optimize patient outcomes

　　6) Identifies insurance treatment requirements and assures the requirements are met for prior authorization approval.

　　7) Maintain patient records in a timely and complete manner.

　　8) Becomes proficient in the use of ICD-9, ICD-10 and CPT codes

　　9) Accurately utilize applicable computer software and equipment for access processing

　　10) Receives refill requests and queues up prescription renewals for patients with whom the coordinator has ongoing contact.

　　11) Builds strong work relationships with departmental staff.

　　12) Follows established departmental rules, procedures, policies, quality-improving objectives, environmental, safety and/or infection controlling standards.

　　13) Attends departmental meetings and/ or documents review of meeting minutes

　　14) Responsible for own professional development including meeting all requirements for continuing education, and keeping abreast of current professional literature, both from a clinical and medication safety perspective.

　　15) Actively participates in continuous performance improvement activities of the department, including providing suggestions on how to improve day-to-day operations

　　16) Has completed all organizational and departmental competency requirements.

　　17) Performs assigned projects in an efficient and timely manner

　　18) Performs additional tasks as assigned.

　　Minimum Qualifications:

　　Education:

　　High School Diploma or GEDLicensure, Certification & Registration:

　　State of Massachusetts Registered Pharmacy Technician; PTCB Certification for Pharmacy Technicians.Experience:

　　2+ years of clinical experience within a healthcare environment (e.g. hospital, retail, managed care etc.)

　　Experience in prior authorization submission process

　　Skills, Knowledge & Abilities:

　　Knowledge will include, at minimum, prior-authorization workflows, payer relations, prescription claims adjudication, and general reimbursement procedures.

　　Uses excellent customer service, written and oral communication skills.

　　Ability to understand and follow specific instructions and procedures.

　　Superior communication skills

　　Demonstrated knowledge of insurances, drug formularies and drug products

　　At least one year of pre-cert experience, including navigating websites for online benefit reviews.

　　Excellent clerical, computer, multi-tasking, resource management and phone skills

　　Skill in the use of personal computers and related software applications.

　　Creative thinking and problem-solving skills, and ability to work well under pressure (most of the paperwork is time sensitive)

　　Ability to understand importance of and respect for the confidentiality of all patient information in accordance with applicable standards and regulations.

　　TEAM PLAYER and willing to be diversified.

　　FLSA Status:

　　Non-Exempt

　　As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) and COVID-19 as a condition of employment. Learn more (https://www.bilh.org/newsroom/bilh-to-require-covid-19-influenza-vaccines-for-all-clinicians-staff-by-oct-31) about this requirement.

　　More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger.

　　Equal Opportunity Employer/Veterans/Disabled