Prior Authorization Specialist

Remote Care Coordination Representative *

Experience with DME & Diagnostic Testing Prior Authorizations

* Summary of Position: The Care Coordination Representative is responsible for completing tasks related to assigned Care Coordination services (CCS) / Health Information Management (HIM) service. CCS services include e-Filing (electronic filing), order and referral management, insurance verifications, prior authorizations, and completing patient medical forms. The Care Coordination Representative reports directly to the Operations Supervisor. This position may be onsite, hybrid and/or remote allowing you to work from your own home office environment. Duties & Responsibilities:

• Process assigned tasks with a focus on accuracy, efficiency, and compliance with client protocols
• Evaluate medical documents and file them electronically into patient charts
• Navigate client electronic health records(EHR)software and internal systems with ease
• Ability to handle high volumes of work with high quality and accuracy
• Utilize strong data entry and typing skills with ability to move quickly on a keyboard
• Crosstrain in multiple EHRs to provide additional team coverage when needed
• Follow pre-defined filing processes, and if needed, refer to company internal documentation, or ask your supervisor for assistance in filing the document properly
• Understand and utilize assigned clients’ protocols and Service Level Agreement
• Track your completed work to log time and transaction counts on an hourly basis or as directed by management
• Know the PGLs(Planning Guidelines) or Target Transactions per Hour for the client accounts you are working on
• Complete all work as assigned by management
• Report to management any reasons for a variance to standard, including all issues preventing or delaying planned job completion, and report any actions taken to resolve
• Study and continually reference internal documentation and protocols
• Exercise confidentiality concerning the affairs of the business and follow HIPAA guidelines and procedures; report all HIPAA violations, maintain good HIPAA practices
• Expected to provide exemplary customer service to all, including external customers, vendors, visitors, coworkers, and management, with clear and effective communication, professionalism, and courtesy while representing the company
• Attend any meetings or training as required
• Understand and comply with company/client agreed compliance standards
• Understands that this role requires specific responsibilities for protecting sensitive data
• Perform other duties, as assigned, to ensure effective operation of the department and the Company

Minimum Qualifications:

• High School Diploma or equivalent required
• Experience with health information management concepts, EHRs and/or medical terminology is a plus
• Proficient in managing a high-volume, fast-paced environment with accuracy
• Intermediate computer skills, including Microsoft Office Suite and the ability to adapt to company-specific software
• Capable of efficiently navigating multiple open programs, windows and applications
• Strong attention to detail and accuracy
• Must be able to perform physical tasks such as sitting, talking, hearing, using hands, reaching, standing, walking, driving, and occasionally lifting up to 25 lbs
• Occasional after-hours or weekend work may be required
• Ability to fulfill responsibilities in a remote capacity while ensuring access to strong/reliable internet within a designated, secure and private workspace

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