Coordinator, Prior Authorization (Surgical ASG) - 40 hours, days

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This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.

At UMass Memorial Health, everyone is a caregiver - regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 16,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day.

• Maior Responsibilities:

• Completes prior authorization process for all testing, imaging and surgical procedures ordered within the ASG; schedules testing and imaging appointments once authorization is obtained. Completes regular audits and resolves issues.
  * Works with multiple insurance carriers/vendors and keeps current with any and all changes as they relate to prior authorization.
  * Communicates / interacts with specific divisions in the ASG regarding approved or denied prior authorizations. Communicates with Insurance Verification, the Central Billing Office and other Departments in order to resolve prior authorization issues.
  * Manages the daily "Missing Prior Authorization" report received from Insurance Verification.
  * Coordinates process for authorization using defined best practices; specifically internet applications.
  * Participates in the management of a shared internet site which holds all prior authorization numbers and makes edits as needed.
  * Assists in the maintenance of the Prior Authorization Best Practices manual which includes prior authorization requirement changes made by the insurance carriers and makes recommendations for changes.
  * Performs weekly prior authorization audit to ensure accurate billing and resolves issues that arise.
  * Produces correspondence, reports, memos, etc. from dictation drafts, models, etc. as required.
  * Sets up and maintains confidential, sensitive files and records for multiple functions, academic materials, medical records, etc. ensuring efficient retrieval of information. Coordinates retrieval of medical records.
  * Ensures adequate inventory of office supplies and basic maintenance of office equipment.
  * Participates in performance improvement initiatives and demonstrates the use of quality improvement in daily operations.
  * Ensures compliance with health and satiety requirements and with regulatory agencies such as DPH, etc.
  * Complies with established departmental policies, procedures, and objectives.
  * Attends variety of meetings, conferences, and seminars as required or directed.
  * Demonstrates use of quality improvement in daily operations.
  * Complies with all health and safety regulations and requirements.
  * Respects diverse views and approaches, and contributes in maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors.

  Standard Staffing Level Responsibilities:
  1. Complies with established departmental policies, procedures and objectives.
  2. Attends variety of meetings, conferences, seminars as required or directed.
  3. Demonstrates use of Quality Improvement in daily operations.
  4. Complies with all health and safety regulations and requirements.
  5. Respects diverse views and approaches, demonstrates Standards of Respect, and contributes to creating and maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors.
  6. Maintains, regular, reliable, and predictable attendance.
  o Performs other similar and related duties as required or directed.
  * All responsibilities are essential job functions.

  II. Position Qualifications:
  License/Certification/Education:
  Required:
  1. High School diploma

  Experience/Skills:
  Required:
  1. 2-3 years of medical secretarial/administrative support experience.
  2. Microsoft Office and internet skills required.
  3. Good customer service skills. Ability to work in a team environment.

  Preferred:
  1. 6 -12 months of prior authorization experience in a medical group/ASG setting preferred.
  2. Prior experience using All Scripts, IDX, preferred.

  Unless certification, licensure or registration is required, an equivalent combination of education and experience which provides proficiency in the areas of responsibility listed in this description may be substituted for the above requirements.

  Department-specific competencies, including age-specific competencies and their measurements, will be developed and maintained in the individual departments. The competencies will be maintained and attached to the departmental job description. Responsible managers will review competencies with position incumbents.

  III. Physical Demands and Environmental Conditions:

  Work is considered sedentary. Position requires work indoors in a normal office environment.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

We're striving to make respect a part of everything we do at UMass Memorial Health - for our patients, our community and each other. Our six Standards of Respect are: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player and Be Kind. If you share these Standards of Respect, we hope you will join our team and help us make respect our standard for everyone, every day.

As an equal opportunity and affirmative action employer, UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives and backgrounds. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity and expression, protected veteran status or other status protected by law.

If you are unable to submit an application because of incompatible assistive technology or a disability, please contact us at talentacquisition@umassmemorial.org. We will make every effort to respond to your request for disability assistance as soon as possible.