insurance authorization coordinator

Blanchard Valley Health System

<div><p><b>PURPOSE OF THIS POSITION</b></p><p>
The primary purpose of this position is to plan and coordinate the authorization functions for BVHS patients. Act as a liaison between the physicians, facilities, patients and professional billing companies. Coordinates information between patients, their insurance companies, and the facilities at which the patient is being served. Responsible for accurately entering patient data and interpreting insurance verification and coverage for patients.</p><p><b>
JOB DUTIES/RESPONSIBILITIES</b></p><ul>
<li>
Duty 1: Ability to process patient authorizations in a timely manner with accurate data.</li>
<li>Duty 2: Ability to use current EHR system and all insurance verification and authorization tools, identifies and confirms active insurance coverage and required authorizations for outpatient and inpatient services. Ability to discover/provide clinical data in the EHR or from the ordering provider to support authorization needs.</li>
<li>Duty 3: Ability to effectively communicate with insurance and governmental agencies in order to have complete and accurate procedure authorizations and approvals.</li>
<li>Duty 4: Ability to professionally communicate to all patients and office staff, and meet age specific requirements for handling their requests.</li>
<li>Duty 5: Continue to stay informed of any statute and/or regulation that could affect Authorization requirements.</li>
<li>Duty 6: Work through the retro auth request lists, working with denials, and have the ability to timely address order/rad changes that may affect an authorization.</li>
<li>Duty 7: Acts as a liaison between the facility, patient/family and ordering provider to resolve problems and/or address complaints.</li>
<li>Duty 8: Participates in a variety of unit and hospital educational programs to maintain current skills and competency levels. Participates in and fully supports new hire and other department training and shadowing. Provides a positive learning environment and compassionate mentoring.</li>
<li>Duty 9: Has ability to problem solve and offers assistance as needed to all customer groups.</li>
<li>Duty 10: Performs all duties and responsibilities in a manner consistent with and supportive of the mission and value statement of Blanchard Valley Health System.</li>
</ul><p><b>
REQUIRED QUALIFICATIONS</b></p><ul>
<li>
High school graduate or GED equivalent</li>
<li>Data entry and/or PC experience required</li>
<li>Medical terminology coursework or knowledge required</li>
<li>BWC, VA, Medicare, Medicaid and commercial healthcare insurance knowledge</li>
<li>Positive service-oriented interpersonal and communication skills required</li>
<li>Individual must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patient served on his/her assigned unit/department. The individual must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to assess data reflective of the patient status. Must be able to interpret the appropriate information needed to identify each patient&rsquo;s requirements relative to their age-specific needs and to provide the care needed as described in the area&rsquo;s policies and procedures.</li>
</ul><p><b>
PREFERRED QUALIFICATIONS</b></p><ul>
<li>
Some related college preferred</li>
<li>Insurance verification and authorization submission/verification experience preferred</li>
<li>Knowledge of current EHR and insurance verification/authorization software</li>
<li>Ability to meet remote work requirements.</li>
</ul><p><b>
PHYSICAL DEMANDS</b></p><p>
This position requires a full range of body motion with intermittent walking, lifting, bending, climbing, squatting, kneeling, twisting, sitting and standing. The associate must be able to lift 20-30 pounds or more. The individual must have excellent eye-hand coordination with the ability to grasp, push and pull, have fine fingers dexterity and manipulation. The associate must be able to reach work above the shoulders. This position requires corrected vision and hearing in the normal range. The associate must have excellent verbal skills to communicate with patients, physicians, and co-workers.</p><p><b>
This position is classified &ldquo;at risk&rdquo; for possible occupational exposure to blood borne pathogens (HBV, HIV, etc.)</b></p></div>
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</div><div></div><div><h3 class="jobSectionHeader"><b>Job Snapshot</b></h3>
<div><h4 class="jobSectionHeader"><b>Employee Type</b></h4>
Per Diem
</div><div><h4 class="jobSectionHeader"><b>Street Address</b></h4>
1900 South Main Street
</div><div><h4 class="jobSectionHeader"><b>Location Map</b></h4>
</div><div><h4 class="jobSectionHeader"><b>Date Posted</b></h4>
03/10/2026
</div><div><h4 class="jobSectionHeader"><b>Job ID</b></h4>
19726
</div><div><h4 class="jobSectionHeader"><b>Shift</b></h4>
1st</div></div></div>

Patient Access Authorization Specialist (PRN)

DeCoach Recovery Centre

<div><div><p><b>Prior Authorization Specialist</b></p><p><b>
Job Description</b></p><div>
DeCoach Recovery is a leading addiction treatment center located in Sharonville, OH, dedicated to providing compassionate care and effective solutions for individuals battling addiction. We are seeking a detail-oriented and experienced Prior Authorization Specialist to join our team.</div><p>
Job Overview: We are seeking a detail-oriented and energetic Prior Authorization Specialist to join our team. In this vital role, you will manage the authorization process for various medical services, ensuring timely approval from insurance providers. Your expertise will help streamline patient care, reduce delays, and enhance overall satisfaction by navigating complex managed care protocols with precision and professionalism.</p><p><b>
Key Responsibilities:</b></p><ul><li>
Review and prepare prior authorization requests for medical procedures, medications, and treatments</li><li>
Verify insurance coverage and eligibility through insurance verification processes</li><li>
Accurately code procedures using CPT (Current Procedural Terminology), ICD-9, ICD-10, and ICD coding systems</li><li>
Maintain comprehensive medical records and documentation in compliance with HIPAA regulations</li><li>
Communicate effectively with healthcare providers, insurance companies, and patients to facilitate authorization approvals</li><li>
Track and follow up on pending authorizations to ensure timely responses</li><li>
Stay current with changes in managed care policies, coding standards, and regulatory requirements</li></ul><p><b>
Qualifications:</b></p><ul><li>
Proven experience in managed care or medical office environments, preferably with prior authorization responsibilities</li><li>
Strong knowledge of medical terminology, medical records management, and medical coding (CPT, ICD-9, ICD-10)</li><li>
Familiarity with insurance verification processes and healthcare billing procedures</li><li>
Experience working in dental or medical offices is highly desirable</li><li>
Excellent organizational skills with attention to detail and accuracy</li><li>
Ability to navigate HIPAA regulations diligently to protect patient confidentiality</li><li>
Office experience demonstrating proficiency with electronic health records (EHR) systems or similar software</li></ul><p><b>
Benefits:</b></p><ul><li>
Competitive salary based on experience.</li><li>
Medical, Dental, &amp; Vision Heath Insurance</li><li>
Company Paid Life Insurance</li><li>
Affiliated with the STAR program, assist employees in paying off student loans</li><li>
Tuition Reimbursement program</li><li>
Paid Time-Off</li><li>
6 paid Holidays off</li><li>
Opportunities for Advancement</li><li>
Yearly Merit Raises</li></ul><p>
Join our dedicated team at DeCoach Recovery and contribute to our mission of providing quality addiction treatment services while ensuring financial sustainability through effective revenue cycle management. If you have the required skills and experience, we encourage you to apply and become part of our compassionate and dynamic team.</p></div><br>
8-4:30</div>

Prior Authorization Specialist

Elevate Patient Financial Solutions

<div><div><b>Elevate Patient Financial Solutions </b>has an exciting career opportunity available as a <b>Bilingual Scheduling and Authorization Coordinator.</b> This position will be a remote role <b>required to live in the Pacific or Mountain time zones</b>. The Full-Time schedule for this role will be <b>Monday through Friday 8 AM to 5 PM (PST or MST required).</b></div>
<div></div><div><b>Job Summary</b></div>
<div></div><div>The Scheduling and Authorization Coordinator delivers exceptional customer service when communicating with patients over the phone to provide the necessary information for applicable scheduling and imaging. They request information related to the coordination and scheduling of diagnostic imaging and other procedures and treatments for hospitals contracted with ElevatePFS&reg;. The Scheduling and Authorization Coordinator interacts directly with the patients, referring physicians, Hospital Services</div>
<div>, and internal company associates to guarantee smooth coordination of procedures and exams.</div>
<div></div><div><b>Essential Duties and Responsibilities</b></div>
<div></div><div><b>Insurance Authorization/Verification</b></div>
<div></div><ul><li>Thoroughly completes the insurance verification process to ensure the accuracy of insurance information.</li>
<li>Obtains insurance authorizations, referral, and treatment consults as needed for all scheduled patients prior to receiving services.</li>
<li>Obtains benefit coverage from insurance companies and accurately enters information into the appropriate computer system.</li>
<li>Obtains diagnosis information and/or CPT code from the physician/office or the outpatient department, as necessary for completing the insurance authorization process.</li>
<li>Maintains proficiency in the various systems utilized during insurance verification and authorization process including various on-line payor eligibility programs.</li>
<li>Monitors appropriate work lists to ensure timely insurance verification processing.</li>
<li>Maintains documentation necessary for compliance with state, federal, and other regulatory agency requirements.</li>
<li>Maintains proficiency in the various systems utilized during insurance verification and authorization process including various on-line payor eligibility programs.</li>
</ul>
<div></div><div><b>Scheduling</b></div>
<div></div><ul><li>Schedules all types of complex exams with attention to detail.</li>
<li>Ability to manage high outbound and inbound calls to schedule patients for imaging services to ensure the best possible customer service by properly educating the patient on exam preparation and answering questions.</li>
<li>Screens and verifies all HIPPA information to ensure accuracy with scheduling and speaking with patients, patients approved representatives and or physicians.</li>
<li>Schedules and documents notes in hospital and ElevatePFS&reg; operating systems.<br>
</li></ul><div><b>Clerical</b></div>
<div></div><ul><li>Monitors and manages the e-mail inbox or fax machine for assigned practices throughout the day.</li>
<li>Works any requests received via e-mailed or fax.</li>
<li>Checks and responds to voicemails.</li>
<li>Creates, maintains and monitors log of patients and procedures scheduled for assigned physician practices.</li>
<li>Monitors appropriate work lists to ensure timely insurance verification processing.</li>
<li>Utilizes multiple commuter application, scheduling software, network, drives to schedule multiple exams within multiple modalities and entities across the hospitals system.</li>
</ul>
<div></div><div><b>Additional Responsibilities</b></div>
<div></div><ul><li>Effectively communicates operational activities and issues with Supervisor and Manager.</li>
<li>Interfaces courteously and effectively with internal and external customers. Must consistently present a positive departmental and organizational image, as well as commitment to departmental goals, objectives, standards, policies and procedures.</li>
<li>Demonstrates proficiency within assigned area of responsibility and a general understanding of the entire Patient Access process.</li>
<li>Adheres to the hospitals and until level policies and procedures and safeguards set forth by each facility.</li>
<li>Identifies and recommends process improvements for RMA services.</li>
<li>Other duties as assigned.</li>
</ul>
<div></div><div><b>Qualifications and Requirements</b></div>
<div></div><ul><li>High school diploma or GED</li>
<li>Associate degree or 2+ years in patient scheduling, registration, or healthcare billing is preferred</li>
<li>Over one (1) year working in a customer service or client relations type role</li>
<li>Effectively communicate both orally and written, to a variety of individuals utilizing fluent Spanish and English.</li>
<li>Office or hospital environment experience is preferred</li>
<li>High volume call center experience is preferred</li>
<li>Strong Literacy (grammar, spelling, math)</li>
<li>Strong Microsoft Products experience, including word, excel, outlook, windows</li>
<li>Familiarity with HCA/Parallon IT systems is preferred</li>
<li>Strong sales and customer service skills</li>
<li>Excellent interviewing and telephone communication skills</li>
<li>Outstanding interpersonal and people‑oriented skills</li>
<li>Excellent written and verbal communication abilities</li>
<li>Ability to communicate assertively and professionally while maintaining confidence and credibility.</li>
<li>Strong analytical, problem‑solving, and decision‑making skills</li>
<li>High level of organization, attention to detail, and time management</li>
<li>Ability to multitask and prioritize effectively in a fast‑paced environment</li>
<li>Proven ability to work independently with minimal supervision</li>
<li>Strong stress management and adaptability skills</li>
<li>Goal‑driven with a strong action and results orientation</li>
<li>Demonstrates initiative, persistence, and a strong work ethic</li>
<li>Team‑oriented with the ability to collaborate effectively</li>
<li>Flexible and adaptable to changing priorities</li>
<li>High standards of honesty, integrity, and professionalism</li>
<li>Profit‑ and performance‑oriented mindset</li>
<li>Remote and hybrid positions require internet connectivity that meet the Company&rsquo;s upload and download requirements.</li></ul><br>
<div>
</div><div></div><div><br>
<b>Benefits</b></div>
<div></div><div>ElevatePFS believes in making a positive impact not only within our industry but also with our employees &ndash;the organization&rsquo;s greatest asset! We take pride in offering comprehensive benefits in a vast array of plans that contribute to the present and future well-being of our employees and their families.</div>
<ul><li>Medical, Dental &amp; Vision Insurance</li>
<li>401K (100% match for the first 3% &amp; 50% match for the next 2%)</li>
<li>15 days of PTO</li>
<li>7 paid Holidays</li>
<li>2 Floating holidays</li>
<li>1 Elevate Day (floating holiday)</li>
<li>Pet Insurance</li>
<li>Employee referral bonus program</li>
<li>Teamwork: We believe in teamwork and having fun together</li>
<li>Career Growth: Gain great experience to promote to higher roles</li></ul><br>
<div></div><div>The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, location, specialty and training. This pay scale is not a promise of a particular wage.</div><br>
<div></div>
<div></div><div><i>The job description does not constitute an employment agreement between the employer and Employee and is subject to change by the employer as the needs of the employer and requirements of the job change.</i></div>
<div></div><div><b>Elevate, PFS is an Equal Opportunity Employer</b></div></div>

Bilingual Scheduling and Authorization Coordinator (PST or MST location required)

MGA Homecare

<div>Central Intake Coordinator<p><b>
Job Overview
</b></p><p><b>Duties and Responsibilities</b></p><p><b>
MUST LIVE IN CST or EST TIME ZONES</b></p><ul><li>
Organization Communication<ul><li>
Handles all daily patient referrals and intake operations, reviews, and processes pending referrals</li><li>
Enters all demographic and insurance information for new customers and updates as needed</li><li>
Completes registration of clients into the home care management program in an accurate and timely manner</li><li>
Informs location staff of received referral/s with full details on deductible, coinsurance, and copay</li><li>
Adheres to the rules regarding confidentiality of HIPAA protected health information</li><li>
Assists with the identification and reporting of potential quality management and noncoverage issues</li><li>
Communicates with relevant parties to obtain authorization of home health services, initial and ongoing Interfaces with providers/office staff/clinical staff/caregivers for the purpose of attaining additional information required for authorization approval</li><li>
 Provides direct support regarding utilization, authorization, and referral activities</li><li>
Contacts providers and families with authorization, denial, and appeals process information</li><li>
Completes monthly authorization expiry reports and informs location of upcoming renewals</li><li>
Completes all changes to health insurance in KanTime</li></ul></li><li>
Verification<ul><li>
Verifies eligibility of members and member benefit coverage at initial start of care and ongoing eligibility and benefits verification on the 1st and 15th of each month</li><li>
Reports all discrepancies to the Director of Clinical Services, Director of Therapy, Account Manager, and Director of Central Intake</li></ul></li><li>
Insurance knowledge experience<ul><li>
General knowledge of state Medicaid plans, private insurance plans, Medicare and Veteran Affairs</li></ul></li></ul><ul><li>
Performs all other duties assigned by Director of Central Intake</li><li>
Supports and executes the mission, ethics, and goals of the company effectively<ul><li>
 Represents themselves in a positive and professional manner in the company and community</li><li>
Adheres to dress code with a clean and neat professional appearance</li><li>
Reports on time and as scheduled to complete work within designated time</li><li>
Adhere to all company policies and procedures outlined in Employee Handbook, Employee Agreement, or communicated from executive team</li></ul></li></ul><p></p><p><b>
Requirements</b></p><ul><li>
High School Education- Associates Degree preferred</li><li>
 Exceptional Customer Service</li><li>
 Must be detailed oriented</li><li>
 Familiarity with ICD-10 coding</li><li>
 Able to work independently</li><li>
 Able to work remotely</li><li>
 Ability to perform basic to intermediate applications with Excel</li><li>
 Strong verbal and written communication skills (Additional languages preferred)</li><li>
 1+ year experience in a clinical environment preferred</li><li>
 Requires in depth knowledge of benefits and authorizations</li><li>
 Proficient use of standard computer programs for data entry and data organization</li></ul><p><b>
Additional Job Description Information</b></p><p>
#IND123</p><p><b>
EEO Statement:</b></p><p>
MGA is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other status protected by applicable law.</p></div>

Central Intake Coordinator

Reach for the Top Therapy Services

<p><b>Are you ready to make a difference in our community and watch your expertise positively impact children and families with complex needs? Do you enjoy being part of a dynamic team in a fast-paced environment? Are you a life-long learner that values opportunities for growth?</b> If so, then being the billing and insurance coordinator for our program might be your next career move. This position is vital to the success and growth of our clinic.</p><p>Reach for the Top Therapy Services is an outpatient pediatric rehabilitation facility in Dover NH. We are seeking the right candidate to serve as the billing and insurance coordinator for our fast-paced clinic serving children birth through twenty-one.</p><p>The billing and insurance coordinator must possess <b>excellent critical thinking and interpersonal customer service skills </b>and the ability to demonstrate <b>high-level problem-solving skills</b> to capitalize on maximizing schedule outcomes and family satisfaction.</p><p>The best candidate will have 3 years of customer service experience, in a clinical health care environment; at least 1 year of hands-on experience with scheduling in a medical setting.</p><p><i><b>Additional Benefits</b></i></p><ul><li><i>Generous Paid Time Off Package</i></li><li><i>6 Paid Holidays (NYD, Memorial Day, 4 of July, Labor Day, Thanksgiving, Christmas)</i></li><li><i>Flexible Schedule Options including: Ability to build your own schedule including work from home as outlined within Reach&rsquo;s policy (i.e. due to illness or weather), flex hours within same week to decrease PTO usage</i></li><li><i>PTO buy back annually of up to 20 hours</i></li><li><i>Mentorship provided immediately upon hire</i></li><li><i>Anthem Health Insurance Plan with $4,000 employer contribution</i></li><li><i>Dental Insurance with employer contribution</i></li><li><i>Company Sponsored Life Insurance Policy</i></li><li><i>Short-Term Disability</i></li><li><i>401K with 1% match</i></li><li><i>Parental leave package</i></li><li><i>We are a 501c3; eligible for federal Non-Profit Student Loan Forgiveness</i></li><li><i>Weekly mentoring and professional development training provided at all levels</i></li></ul><p><b>MAJOR DUTIES AND RESPONSIBILITIES:</b></p><p>1. Obtaining insurance authorization for both Allied Health and Behavioral Health services</p><p>2. Verifying commercial insurance and Medicaid policies</p><p>3. Overseeing &amp; following up on all insurance issues</p><p>4. Addressing all denials in coordination with the Biller</p><p>5. Obtaining all MD scripts and referrals as needed</p><p>6. Oversee follow up on all referrals</p><p>7. Oversee collection of co-pays and patient balances completed weekly for prompt revenue recovery</p><p>8. Oversee accounts are accurate and send monthly patient payment bills (collaborate with biller as needed)</p><p>9. Collaborate with Director of Operations, by updating collections spreadsheet weekly to ensure timely collections of past due accounts</p><p>10. Open and distribute the mail</p><p>11. Log and secure all incoming checks</p><p>12. Strong communication within the administrative team in collaboration with the Director of Operations to ensure delegation for the effective and efficient functioning of the clinic</p><p>13. Maintaining prior authorization spread sheet and sending reminders to clinicians when they are due</p><p>14. Overseeing and addressing all faxes</p><p>15. Ensuring all patient demographic, claims, &amp; payment information is accurate and updated as necessary</p><p>16. &amp; any other responsibilities necessary to ensure the effective and efficient functioning of the clinic</p><p><b>MINOR DUTIES AND RESPONSIBILITIES</b></p><p>17. Making and receiving phone calls as needed throughout the day</p><p>18. Assist Scheduling Coordinator in checking phone messages and informing the appropriate party</p><p>19. Assist administrative team in making patient charts as needed</p><p>20. Assist Scheduling Coordinator with scheduling patients &amp; coverage as needed</p><p>21. Assist in monitoring cancellations and rescheduling patients as needed</p><p>22. Assisting in the cleanliness of the clinic and administrative space</p><p>23. &amp; any other responsibilities necessary to ensure the effective and efficient functioning of the clinic</p><p>Qualifications and Education Requirements</p><p>Associate degree or equivalent with a minimum of 3 years of experience</p><p>Experience</p><p>&middot; Medical insurance experience</p><p>&middot; Office administration experience</p><p>&middot; Rehab office experience preferred</p><p>&middot; Knowledge of billing and coding</p><p>Key competencies</p><p>&middot; Computer skills</p><p>&middot; EMR experience</p><p>&middot; Working with insurance companies</p><p>&middot; Working with families and children</p><p><i>Qualified applicants will receive consideration for employment without regard to their race, color, religion, national origin, sex, sexual orientation, gender identity, protected veteran status or disability.</i></p><p><i>All applicants must have reliable transportation to work and have a demonstrated history of reliability in prior employment. Any candidate who is offered a position will be required to submit to a background check.</i></p><p><i>Website: https://reachftt.org/</i></p><p>Job Type: Full-time</p><p>Pay: $22.00 - $26.00 per hour</p><p>Benefits:</p><ul><li>401(k)</li><li>401(k) matching</li><li>Dental insurance</li><li>Employee assistance program</li><li>Flexible schedule</li><li>Health insurance</li><li>Life insurance</li><li>Paid time off</li><li>Parental leave</li><li>Referral program</li><li>Retirement plan</li><li>Vision insurance</li></ul><p>Ability to Commute:</p><ul><li>Dover, NH 03820 (Preferred)</li></ul><p>Work Location: In person</p>

Billing and Insurance Coordinator

ClinLab Solutions Group

<div>
 <p>
  <strong>
   Job Description:
  </strong>
 </p>
 <p>
  The Surgery Scheduler / Patient Care Coordinator schedules all surgical procedures and assures that all of the appropriate clinical and insurance coding information is collected for the surgery schedule. They will request to schedule procedures from physician offices and schedule the procedure according to established guidelines. They will provide accurate information so that all department may view daily and maintains open communication with hospital department and physician offices regarding schedule changes. They will act as a central key administrative assistant who will rotate and fulfill administrative duties, dependent on the needs and requirements of the clinic. They will provide coordination of care, continuity, follow-up, and support for the patients and their families. Duties are anticipated to change daily.
 </p>
 <p>
 </p>
 <p>
  <strong>
   Essential Functions:
  </strong>
 </p>
 <p>
  <em>
   The following reflects management&rsquo;s definition of essential functions for this job but does not restrict the tasks that may be assigned. Management may assign or reassign duties and responsibilities to this job at any time with reasonable accommodation.
  </em>
 </p>
 <ul>
  <li>
   Schedules surgery procedures using OncoEMR.
  </li>
  <li>
   Answers the phones in a professional and courteous manner.
  </li>
  <li>
   Completes daily surgical schedule.
  </li>
  <li>
   Assures appropriate coordination with other hospital departments when special surgical needs occur.
  </li>
  <li>
   Publishes an accurate daily call list and forwards to staffing department
  </li>
 </ul>
 <p>
 </p>
 <ul>
  <li>
   <strong>
    Surgery
   </strong>
  </li>
  <li>
   Sending Orders to NMS to obtain authorization.
  </li>
  <li>
   Calls patient provides surgery/ pre-op /post-op instructions.
  </li>
  <li>
   Once the authorization is obtained NMS notifies coordinator and will coordinate with hospital for surgery date.
  </li>
  <li>
   Coordinate and assist the surgeon.
  </li>
  <li>
   Adds to surgery calendar.
  </li>
  <li>
   Calls patient with the date of surgery and schedule their post-op appointment.
  </li>
 </ul>
 <p>
 </p>
 <ul>
  <li>
   <strong>
    Patient Care Coordinator
   </strong>
  </li>
  <li>
   Conduct incoming/outgoing calls to patients in response to new patient referrals, in a professional and courteous demeanor.
  </li>
  <li>
   Assist patients with the completion of all necessary intake paperwork.
  </li>
  <li>
   Create new patient charts using the practice management and EMR system.
  </li>
  <li>
   Obtain all necessary demographic and insurance information.
  </li>
  <li>
   Conduct insurance checks prior to scheduling a patient to ensure in-network eligibility.
  </li>
  <li>
   Assign and schedule new patients according to practice referral guidelines.
  </li>
  <li>
   Request and retrieve all records from outside physicians and hospitals that pertain to the first appointment.
  </li>
  <li>
   Maintain accurate daily records of new patient tracking for administrative team.
  </li>
  <li>
   Protect patient privacy by adhering to the HIPAA confidentiality guidelines.
  </li>
  <li>
   Contribute to a team effort by communicating effectively with other departments, as needed.
  </li>
  <li>
   Maintain daily operations of the office by following standard policies and procedures.
  </li>
  <li>
   Assist patients by providing translation services, as required.
  </li>
 </ul>
 <p>
 </p>
 <ul>
  <li>
   <strong>
    Radiology
   </strong>
  </li>
  <li>
   Receives the orders from the Provider.
  </li>
  <li>
   Sends to NMS for Auth approval.
  </li>
  <li>
   NMS send back when approved or denied.
  </li>
  <li>
   Fax orders and auth to imaging center.
  </li>
  <li>
   Call patients to provide imaging center information.
  </li>
 </ul>
 <p>
 </p>
 <p>
  <strong>
   Competencies:
  </strong>
 </p>
 <ul>
  <li>
   Knowledge of computer/telephone support, preferably in the healthcare industry.
  </li>
  <li>
   Strong customer service background, preferably in a healthcare setting.
  </li>
  <li>
   Excellent written and verbal communication skills.
  </li>
  <li>
   Competence with computer processing functions and other standard office equipment
  </li>
  <li>
   Ability to collaborate, set priorities, and organize work to meet deadlines, ensuring compliance with established processes, policies, and regulations.
  </li>
  <li>
   Ability to manage and prioritize multiple tasks.
  </li>
  <li>
   Ability to resolve customer issues calmly and professionally with diplomacy and tact.
  </li>
  <li>
   Ability to work independently with minimal supervision.
  </li>
  <li>
   Strong organizational skills.
  </li>
 </ul>
 <p>
 </p>
 <p>
  <strong>
   Additional Requirements:
  </strong>
 </p>
 <ul>
  <li>
   Great Customer Service Skills.
  </li>
  <li>
   Previous Oncology/Hematology experience preferred.
  </li>
  <li>
   Able to travel to satellite clinics when necessary
  </li>
 </ul>
 <p>
 </p>
</div>


Patient Care Coordinator

MEDPOINT MANAGEMENT

<div><h3 class="jobSectionHeader"><b>Summary</b></h3><div>
Thursday-Monday 8am-5pm. The Outpatient UM Coordinator provides effective communication between MSO, IPA providers, and members to coordinate member care. Communication to include accessibility to care, validating contract entities, and ensuring timeliness standards are met. The Outpatient UM Coordinator reports directly to the Outpatient Lead Coordinator under the guidance of the Supervisor.</div><p></p><h3 class="jobSectionHeader"><b>
Duties and Responsibilities:</b></h3><ul><li>
Process authorization requests per state and federal timeliness regulations</li><li>
Validate data entry process for errors</li><li>
Verify member benefits and eligibility upon receipt of treatment authorization request</li><li>
Utilizes authorization matrix, ancillary rosters, DOFR and/or delegation agreements to drive decision-making</li><li>
Coordinates with referral Clinician and/or Medical Director for timely processing</li><li>
Communicate with Medical Directors to facilitate Medical Reviews for non-clinical medical review referrals</li><li>
Outreach to members on adjudication decisions</li><li>
Outreach to providers offices when additional information is needed</li><li>
Maintain knowledge of CMS &amp; Medi-Cal policy guidelines i.e. Medicare LCD vs NCD</li><li>
Identify &amp; inform Case Management Clinician on complex care diagnoses</li><li>
Screen cases for possible California Children Services (CCS) eligible condition</li><li>
Read and maintain email inquiries</li><li>
Collaborate with other departments (i.e. Claims, PNO, etc.) to resolve member/provider matters as needed</li><li>
Data entry for additional requested services, as needed</li><li>
Assist with special projects, as needed</li><li>
Assists other team members with their workload, as needed</li><li>
Regular attendance at UM team meetings</li></ul><p></p><h3 class="jobSectionHeader"><b>
Minimum Job Requirements:</b></h3><ul><li>
High School graduate or GED equivalent</li><li>
One-year medical office experience</li><li>
Knowledge of medical terminology</li><li>
Proficiency in Microsoft Office programs, especially Word and Excel</li><li>
Proficiency in EZCAP a plus</li></ul><p></p><h3 class="jobSectionHeader"><b>
Skills and Abilities:</b></h3><ul><li>
Ability to multi-task while remaining adaptable and flexible to fast-paced environment</li><li>
Reliable, dependable, and accountable</li><li>
Strong customer service skills with good telephone rapport</li><li>
Ability to empathize with complex cases</li><li>
Self-Motivation and ability to work effectively in an independent environment</li><li>
Great critical thinking and problem-solving skills</li></ul><p></p><h3 class="jobSectionHeader"><b>
Salary Range:</b></h3><ul><li>
$21 &ndash; $23 hourly</li></ul></div>

Outpatient UM Coordinator (Thursday-Monday 8am-5pm)

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