Clinical Operations Coordinator I - PA Systems

Description

Company & Position Overview

MedOne is a national, full-service transparent pharmacy benefit administrator headquartered in Dubuque, Iowa and licensed as a third-party administrator (TPA) by the State of Iowa. We are an innovative and fast-paced company looking for employees interested in working for a business where they can make a difference. MedOne is committed to building solutions with the most current technologies available in the marketplace. We operate in a fast-growing industry that supports significant business growth and as a result, wonderful growth opportunities for our employees.

The Clinical Operations Coordinator I - PA Systems works under the direct supervision the Senior Clinical Operations Manager along with a team of licensed pharmacists. Clinical Operations Coordinator I - PA Systems will assist daily operations of MedOne Clinical Programs and Services. MedOne Pharmacy Benefit Solutions will assign each workforce member a level of access based on the individual’s need for electronic patient’s protected health information (ePHI) to perform their job functions.

The ideal candidate will be a self-starter, who is detail-oriented and accurate in their day-to-day work. This candidate should be culture-focused, bringing enthusiasm to the office and offering up new ideas and programs. This candidate should also have experience with a variety of office software (email tools, spreadsheets and databases).

Essential Job Functions

• Support operations of MedOne Clinical Services
• Update Clinical Authorization Criteria and Clinical Review Request Forms under the direction of a Clinical Pharmacist
• Collaborates directly with Clinical Pharmacists to learn and construct time efficient explanations for Prior Authorization determinations
• Configures clinical criteria requirements and workflows in the Prior Authorization platform for clinical team to utilize
• Interfaces with Prior Authorization, ePA, and Claims Adjudication vendors and any other technology support vendors to troubleshoot issues arising in platforms relating to system enhancements and optimization.
• Attends clinical sub-committee meetings, as a non-voting member, to review and complete tasks assigned during meeting relating to system enhancements.
• Utilizes root cause analysis to determine and improve clinical review processes in order to drive positive outcomes and efficiency within the clinical department
• Works cross functionally with member advocates and account managers to ensure accurate client information is presented to physicians, clients, and members
• Supports Data Entry Specialist team as required
• Supports operations of MedOne Pharmacy Services as needed (applicable to in-office personnel)
• Assist the Director of Clinical Review, in addition to other MedOne team members with general business operations related to clinical functions
• Portray the company in a positive image
• Abide by all rules, regulations, and policies of the employer
• Other duties as assigned
  
  

Work Hours

• Full time (greater than 30 hours per week), non-exempt
  
  

Required Experience & Skills

• Must be registered with the state/Iowa Board of Pharmacy as a Pharmacy Technician/Trainee within 30 days of accepting employment (applicable to in-office personnel).
• Working knowledge of medical terminology, HIPAA regulations, ICD-10, NCPDP standards (highly advantageous)
• Must be detail-oriented and precise with data management
• Must have excellent interpersonal, written, and verbal skills
• Strong customer service and teamwork skills
• Must have a strong understanding of Microsoft Office (Word, Excel, PowerPoint)
• Must be able to type at a minimum of 30 words per minute
• Must be able to work independently, meets deadlines, establish priorities, and be flexible
• Must be able to stand/sit for long periods of time within limited space
• Must be able to lift up to 25 pounds
• Working knowledge of date entry services (DES) core functions, with preferred DES experience of 1-2 years.