Prior Authorization Coordinator
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IN THE PERFORMANCE OF THEIR RESPECTIVE TASKS AND DUTIES ALL EMPLOYEES ARE EXPECTED TO ADHERE TO ALL IASIS AND HEALTH CHOICE POLICIES AND PROCEDURES, NCQA STANDARDS, DEPARTMENT SPECIFIC RULES, ANNUAL EDUCATIONAL REQUIREMENTS, IASIS STANDARDS OF CONDUCT, FEDERAL AND STATE CONTRACT REQUIREMENTS, AND ALL OTHER FEDERAL AND STATE LAWS.
* Read, abide by, and demonstrate an understanding of all policies, procedures, contract requirements, and laws that apply to job. Seek clarification from supervisor if ever unclear about a policy, rule, contract provision, or legal obligation.
* Adhere to HIPAA laws at all times; notify Privacy Officer immediately upon learning of a real or potential breach of protected health information.
* Complete initial orientation and annual mandatory educational requirements.
* Participate in quality activities to include: reporting and following up on grievances and complaints, participating in quality/performance improvement projects and accreditation activities.
* Report grievances accurately and timely.
* JOB SUMMARY: The Prior Authorization (PA) Coordinator works closely with the Prior Authorization Nurses to process all Prior Authorization requested services by providers for Health Choice members within established timeframes, following Health Choice criteria and guidelines. The PA Coordinator will interact with both internal and external partners to ensure the members receive their requested services in a timely manner.
REVIEW PRIOR AUTHORIZATION REQUEST:
* Triage the Prior Authorization Queue
* Request Additional Clinical information
* Research availability of Par Provider for Non Par Requested Services
* Process all Approvals Calls and Notifications
* Manage all Prior Authorization Peer to Peer Request
* Manage the Denial Letter process
ASSIST PROVIDERS IN UTILIZING THE HEALTH PLAN TO MEET THE MEMBERS HEALTH CARE NEEDS:
* Educate and assists providers on proper utilization of the Health Plan
* Research and follow up on unresolved Provider request
* Work with Plan Network/Provider Relations to process and complete all Letter of Agreements
PROFESSIONAL COMPETENCIES (KNOWLEDGE, SKILLS, AND ABILITIES):
Proper customer service techniques
Knowledge of Prior Authorization role in a Care Management Organization
2 years experience working Utilization Management team preferred
Computer experience necessary
Effective time management skills
Effective interpersonal and communication skills
Use of a multi-line phone
Work respectfully and positively with members and providers
Ability to manage multiple projects and prioritize work tasks to adhere to deadlines and identified time frames
Ability to work closely with a clinical nursing team
Ability to handle escalated customer concerns
Complete tasks with little supervision
Ability to supervise and lead others
Ability to think analytically and make independent decisions
Ability to manage large workload
Ability to maintain a positive work environment for employees
Ability to maintain positive work relationships
Able to problem solve
Able to handle fast paced high stress situations
High School Diploma or GED equivalent
Some college preferred
At least two (2) years Utilization Management/ Prior Authorization background preferred
Previous healthcare experience
Job: Authorization Coordinator
Primary Location: Florida-Tampa
Organization: IASIS Integrated Care Solutions
Education Level: High School Diploma/GED
Employee Status: Full Time Benefit Eligible 36-40 hrs/wk
Work Schedule: Days
Equal Opportunity Employer Minorities/Women/Veterans/Disabled