Insurance Prior Authorization Jobs in Remote, OR

WHO WE ARE:

Aviva Health is a dynamic and mission-driven federally qualified health center (FQHC). Committed to providing comprehensive and compassionate healthcare services, Aviva Health offers a holistic approach to care, addressing patients' medical, behavioral health, dental, and social service needs. As a vital healthcare resource in the community, Aviva Health fosters a collaborative and supportive work environment where dedicated healthcare professionals have the opportunity to make a meaningful impact on the lives of individuals and families. Join us at Aviva Health and be part of a team that is dedicated to making a difference in the lives of our patients and the community we serve.

BENEFITS INCLUDED:

• Monday - Friday Scheduling
• Paid Holidays
• PTO
• Comprehensive Medical, Dental, and Vision Coverage
• 403(b) Retirement with Employer Match
  

POSITION PURPOSE:
Under the supervision of the Referrals and Medical Records Supervisor, the Referrals Coordinator utilizes established procedures to assist providers in referring patients to specialists outside of the clinic as appropriate. Ensures efficient and effective flow of internal and external referrals, insurance authorizations for internal and external procedures, and medication pre-authorizations during scheduled clinic hours through joint planning and problem solving with clinic staff. Ability to keep several tasks moving along in a well-organized, compassionate, and professional manner while functioning at a high level of accuracy is critical.

ESSENTIAL FUNCTIONS:
Works out of the electronic medical record (EMR) for referral orders and determine where to refer if the provider has not indicated a specific specialist.
Continuously monitors chart notes and reminds providers of the need for chart notes to be completed after seventy-two (72) hours to process referrals.
Communicates and coordinates with specialists to facilitate scheduling as needed, complete facility referral forms, and fax all pertinent information. Obtain status of appointment, completion of visit, and request office notes to complete the referral process to remain PCPCH compliant.
Communicates with patients any information required for referral appointments as needed. This may include date and time of appointments, location of the specialist, explanation of the process, and expected notification time, insurance status, and changes.
Maintains and processes Veteran Community Care Authorizations for internal and external referrals.
Processes medication prior-authorizations and follows up daily on pending cases. Notifies pharmacies of medication approvals. Communicates with pharmacies to obtain prescription insurance information as needed. Notifies providers of denials and provide guidance regarding insurance guidelines for coverage.
Prioritizes incoming authorization requests according to urgency.
Appropriately forwards all referral service requests to the next level of clinical review as applicable and after verifying for completeness and appropriateness. Communicates with referring practice if information is incomplete, inaccurate, or additional information is needed. Provides updates to the referring practice in each phase of the referral process.
Reviews chart documentation to ensure patients meet medical policy guidelines.
Research member history for duplications and considerations of authorization limits.
Reviews and processes insurance authorizations for internal procedures, imaging, and external facilities as requested. Notifies internal or external facilities when the prior authorization is approved. Reviews denied Prior Authorization requests and providesguidance regarding supporting documentation that may be required for approval and notifies the provider.

Answers the telephone promptly and in a polite and professional manner and makes direct calls to other departments accordingly.
Promotes a strong belief in Aviva Healths philosophy, purpose, mission, and ideals.
Demonstrates Aviva Healths values and approaches all tasks with Aviva Healths Mission, Vision, Values, and Customer Service statements as guidelines. Demonstrates care and compassion, respect, sharing, professionalism, confidentiality, collaboration, and teamwork. Takes personal responsibility.
Promotes positive customer relations and service to both internal and external customers by providing referral services to all patients in a non-discriminatory, confidential, professional, friendly manner that builds dignity for each individual customer. Responds to co-workers needs and requests in a respectful, friendly, and prompt manner.
Demonstrates respect and sensitivity to cultural/social differences in interactions with others.
Displays a high level of initiative, effort, and commitment towards completing assignments efficiently. Works with minimal supervision and demonstrates responsible behavior and attention to detail.
Demonstrates initiative and problem-solving skills using sound judgement. Assumes additional responsibilities as needed, with little or no direction, and shows initiative in assisting others within the department.
Complies with all Aviva Health policies and procedures.
Completes assigned tasks in a timely manner.
Other duties as assigned by supervisor or manager.

QUALIFICATIONS:
High school diploma or GED.
Experience working with insurance in a medical related field, or other related experience.
Ability to develop and maintain positive and effective relationships with medical professionals in the community, with patients, and co-workers.
Knowledge of and compliance with OSHA requirements for the position.
High level of initiative, effort, and commitment towards completing assignments efficiently. Ability to work with minimal supervision; attention to detail.
Ability to maintain professional conduct and appearance, in accordance with organization policies.

WORKING CONDITIONS:
Must be able to perform the following physical requirements:
Remain in a stationary position frequently during the day while performing administrative and supervisory duties.
Move or traverse occasionally during the day around the office.
Operate equipment frequently during the day: computer and other standard office equipment.
Ability to communicate information and ideas clearly and accurately so others will understand; ability to interact with patients and staff clearly.
Able to move or transport up to 5 pounds while transporting laptop or office supplies.
Work indoors in heat-controlled environment 100% of the day.

DISCLAIMER:

Employees must be able to perform the essential functions of their position satisfactorily. Aviva Health will make reasonable efforts to accommodate a qualified applicant or employee with a known disability, unless such accommodation creates an undue hardship on the operation of the business. To request a reasonable accommodation, please contact the Director of Human Resources or their designee by email