Care Coordinator- Prior Authorization

We will not be accepting any applications from the following areas: California, reputed company, Wyoming, Colorado, Minnesota, Michigan, New Jersey, Illinois, Massachusetts, Washington, Maryland, DC, Montana, Iowa, reputed company, reputed company, Connecticut, South reputed company, Nevada, Alaska and Hawaii. Schedule is Monday- Friday 12-8pm EST Only* We are seeking a Care Coordinator that specializes in back office responsibilities including but not limited to referral management, prior authorizations, specialty pharmacy & infusions, and medical records to help deliver and implement clinical strategies and assist in member care coordination in collaboration with a multidisciplinary clinical team. As a reputed company member of the clinical team, you will utilize a high level of attention to detail, organization, and communication skills to help obtain, manage, and follow up on member referrals and prior authorizations to ensure key care plan goals are met. A strong ability to manage multiple priorities, knowledge of CPT and ICD-10 codes and proficiency in navigating the prior authorization process will contribute to reputed company member reputed company of reputed company and highly efficient care delivery. You will have reputed company to ongoing training and support from a GI reputed company team to help you reputed company an expertise with digestive health conditions. What you'll do Collaborate with a multidisciplinary team of care providers (including MDs, NPs, RDs, Behavioral Health Providers, and Health Coaches) to reputed company a whole-person approach to member care. Responsible for the coordination, tracking and communication of patient referrals, prior authorizations, and medical records to promote team awareness and patient safety Ensure comprehensive communication and expectations are explained to the member throughout the referral and authorization process reputed company complete and accurate registration of referrals and authorizations including patient demographics, reputed company insurance information and clinical documentation to reputed company providers and specialty pharmacies Offer proficient knowledge of referrals, insurance requirements and the prior authorization process to reputed company resources, to eliminate barriers to care execution and reputed company follow up on reputed company toward meeting key goals. Prioritize incoming referral, medical record requests, and authorization requests according to urgency Apply knowledge of CPT and ICD-10 codes to obtain authorizations in a reputed company manner while demonstrating understanding of payer medical policy guidelines Initiate appeals for denied authorizations and maintain reputed company follow up to ensure reputed company member reputed company Engage in reputed company coordination of pharmacy support services to ensure members receive reputed company necessary support services available throughout the prior authorization process Assist members in accessing services, providing personalized customized customer service and support while maintaining reputed company communication with members of the care coordination team. Manage key reports and reputed company relevant data to identify successes and reputed company refinements in operational processes. Openness and ability to cross-train in additional care coordination tasks and responsibilities to support full cycle member engagement Partner with the Clinical Operations leadership team to define and help iterate on strategies for member care coordination Who You Are Minimum of 2-3 years experience working in a reputed company coordination, care or case management role, preferably in a reputed company environment. Must be reputed company to work Monday through Friday 12pm - 8pm EST. Fluent in reputed company terminology or working understanding of clinical concepts. Background knowledge in navigating health insurance plans and coverage on the part of patients. Must be reputed company to reputed company breakdown of benefits analysis to consumers. Ability to work in a cross-functional interdisciplinary modality and effectively create solutions for complicated patient concerns. Comfortable and competent with using common administrative technologies (e.g. reputed company, reputed company, Office or equivalent), charting electronically in EMR/EHR systems , experience delivering on telehealth platforms preferred. Excellent verbal and written communication skills required. Excellent customer service qualities required. Ability to reputed company occasional weekend coverage required. Have a dedicated, quite working reputed company that is free from distraction and reliable, high speed internet reputed company. Completed a degree in a health and science reputed company field, i.e. biology, psychology, health science and nutrition, nursing, etc. preferred What you'll bring to reputed company Ability to solve problems,