Medical Office Facilitator

Seeking a Full Time Medical Office Facilitator for BCHP's Pediatric Endocrinology office in Valhalla, NY. Pay rate $20/hr-$22/hr negotiable based on experience.

Duties and Responsibilities

• The role of the Prior Authorization Coordinator is to promptly, efficiently and accurately execute all aspects of the referral process.
• Anticipate our patients needs: Understand the wants and needs of patients, listen for cues and identify how to respond and what level of intervention they need
• Communicate effectively and interact with the provider group and health plans daily or as indicated regarding referral authorization issues
• Data entry
• Process requests that are approved, denied or deferred and bring them to resolution
• Deferred authorization maintenance, tracking, and follow up
• Checks eligibility and benefits on all authorizations prior to processing PAs
• Returns phone calls to customers and follows up with requests
• Maintain patient confidentiality so that HIPAA compliance is observed at all times
• Assists other staff and supports the team approach
• Communicate appropriately and clearly to management, co-workers, and physicians
• Other Duties as assigned

Responsibilities:

• Individual will work with the providers and insurance companies to obtain the necessary pre- Certifications, authorizations and referrals for services ordered/scheduled and for prescriptions.
• Obtain clinical information (Medical History, diagnosis and any relevant laboratory reports) necessary to complete the prior-authorization
• Review the medical records, diagnosis and laboratory reports
• Review Prior Authorization Criteria for medications for Prior Authorization process
• Work with insurance plan to pre-certify/authorize medication
• Ensures insurance carrier documentation requirements are met and authorization/referral documentation is scanned and documented in the patient’s medical record.
• Coordinate with Pharmacies and initiate authorizations.
• Reviews and submits all follow-up authorizations, re-certifications, and referrals.
• Appeals denials and/or set-up peer to peer reviews
• Has knowledge of online authorization sites as well handling them via phone
• Ability to work independently as well as part of a team with flexibility and willingness to learn and take initiative on variety of tasks and projects
• Responsible for the collection and tracking of annual or biannual administrative fees related to form completion mandated by insurance carriers to enable approval to initiate and maintain growth hormone treatment for all non-Medicaid patients
• Assist with Worklog and billing when needed.
• Answer Phones, Check Voicemails, review faxes
• Book new patient/retuning patient appointments.
• Verify Insurance on Phreesia, and call parents if insurance is inactive or if information should be corrected.
• Assist with patient portal, patients questions and concerns

Qualifications:

• Prior medical office experience
• Ability to prioritize and multitask, excellent written and verbal communication skills, strong attention to detail, strong organizational skills.

BCHP will recruit, hire, train, transfer, promote, layoff and discharge associates in all job classifications without regard to their race, color, religion, creed, national origin, alienage or citizenship status, age, gender, actual or presumed disability, history of disability, sexual orientation, gender identity, gender expression, genetic predisposition or carrier status, pregnancy, military status, marital status, or partnership status, or any other characteristic protected by law