Community Health Connections
Prior Authorization Specialist/Front Desk Receptionist
Community Health Connections, Leominster, Massachusetts, us, 01453
Description
Under the general supervision of the Medical Manager, The prior authorization specialist will work closely with the clinical and administrative team to validate patient’s insurance plans, prescriptions and eligibility. Job responsibilities include ability to read prescriptions, convert prescriptions into authorizations and interpret medical records information to abstract relevant data. Prior Authorization Representatives are responsible for contacting pharmacies and other organizations to validate prescriptions, obtain clinical documentation and initiate prior authorizations through insurance plans. The responsibilities of the Front Desk Receptionist include receiving patients, updating patient information, printing an encounter form, booking appointments, cash reconciliation, and cross covering other medical departments as needed as well as working one assigned evening.
Responsibilities include:
Contact plans insurances to validate request
Contact pharmacies and other organizations to validate prescriptions
Obtain clinical documentation and initiate prior authorizations through insurance plans.
Validate that the clinical documentation received is what is required by the plan
Initiate prior authorizations through Cover My Meds and or Insurance Authorization forms
Follow up on all pending PA’s within 48 hours
Obtain approval / denial letters
Submit all new Complex authorization approvals and/or Complex re-authorization approvals through the Complex audit process
Initiate re-authorizations that are set to expire 30 days prior to the term date
Receives and directs incoming patients.
Reviews and updates patient information related to demographics and insurance.
Follows established health center protocol for the check-in, encounter form production, and check-out.
Assists walk-in patients with obtaining appointments and/or picking up prescriptions or completed forms.
Places reminder calls to patients with upcoming appointments.
Follows established health center protocol for daily cash reconciliation.
Schedules walk-in appointments, in collaboration with the Nurse of the Day
Schedules patient appointments according to established protocol.
Minimum Qualifications:
High School Diploma or GED required, associate degree in secretarial science or equivalent preferred.
Bilingual in Spanish preferred
1-year similar work experience or in a medical office environment preferred
Computer skills for accurate data entry
Knowledge of basic medical terminology preferred.
Demonstrated interpersonal relationship skills.
Demonstrated proficiency in reading, writing and speaking in English.
Demonstrated ability to work in a fast paced, high telephone call volume office environment.
Under the general supervision of the Medical Manager, The prior authorization specialist will work closely with the clinical and administrative team to validate patient’s insurance plans, prescriptions and eligibility. Job responsibilities include ability to read prescriptions, convert prescriptions into authorizations and interpret medical records information to abstract relevant data. Prior Authorization Representatives are responsible for contacting pharmacies and other organizations to validate prescriptions, obtain clinical documentation and initiate prior authorizations through insurance plans. The responsibilities of the Front Desk Receptionist include receiving patients, updating patient information, printing an encounter form, booking appointments, cash reconciliation, and cross covering other medical departments as needed as well as working one assigned evening.
Responsibilities include:
Contact plans insurances to validate request
Contact pharmacies and other organizations to validate prescriptions
Obtain clinical documentation and initiate prior authorizations through insurance plans.
Validate that the clinical documentation received is what is required by the plan
Initiate prior authorizations through Cover My Meds and or Insurance Authorization forms
Follow up on all pending PA’s within 48 hours
Obtain approval / denial letters
Submit all new Complex authorization approvals and/or Complex re-authorization approvals through the Complex audit process
Initiate re-authorizations that are set to expire 30 days prior to the term date
Receives and directs incoming patients.
Reviews and updates patient information related to demographics and insurance.
Follows established health center protocol for the check-in, encounter form production, and check-out.
Assists walk-in patients with obtaining appointments and/or picking up prescriptions or completed forms.
Places reminder calls to patients with upcoming appointments.
Follows established health center protocol for daily cash reconciliation.
Schedules walk-in appointments, in collaboration with the Nurse of the Day
Schedules patient appointments according to established protocol.
Minimum Qualifications:
High School Diploma or GED required, associate degree in secretarial science or equivalent preferred.
Bilingual in Spanish preferred
1-year similar work experience or in a medical office environment preferred
Computer skills for accurate data entry
Knowledge of basic medical terminology preferred.
Demonstrated interpersonal relationship skills.
Demonstrated proficiency in reading, writing and speaking in English.
Demonstrated ability to work in a fast paced, high telephone call volume office environment.