Medical - Woon - Prior Authorization Coordinator Level I

Job Description

Job Title: Prior Authorization

Coordinator

Reports to: Pharmacy Team & Prior Auth Support Services Manager

Department:Medical

FLSA Status:Non-Exempt

Job Grade:  4

Version Date: January 2025                                                          

General Responsibilities:

The Prior Authorization Coordinator performs all functions necessary to process, obtain, and close prior authorizations in an accurate and timely manner. Coordinator will complete all documentation/forms and communicate information accurately to external providers/entities to ensure a high-quality patient experience. The coordinator will maintain accurate records and update providers and patients as needed throughout the process.

Qualifications:

Required Qualifications:

• High School graduate/diploma.
• Organizational skills
• Computer literate
• Excellent telephone/customer service skills
• Ability to work independently and with a team.

Preferred Qualifications:

• Post-secondary training in Medical Assistant Program/Professional School
• Bi-lingual in English and Spanish
• 1-year experience working with prior authorizations/referrals
• Candidates who do not meet all of the preferred qualifications are encouraged to apply.

Significant Job Functions:

• Process urgent and routine prior authorizations within expected timeframes.
• Advise patients of prior authorization process and timeline
• Act as a liaison with pharmacies, insurers, and rendering facilities.
• Monitor all prior authorization queues, perform patient outreach, and identify

barriers to bring prior authorization to completion.

• Perform and clearly document appropriate patient outreach and action taken to ensure

timely completion of referral/prior authorization

• Respond by the end of the day to incoming telephone encounters and voicemail

queue in order to provide updates and bring issues to resolution.

• Provide patient with prior authorization coordinator contact information to further

assist with questions.

• Obtain required documents (i.e., labs, DI, progress notes, etc.,) from EMR for attachment to

prior to sending.

• Obtain required records (i.e. consult notes, DI, labs, etc.) from external resources

utilizing (i.e. Cerner, LifeLinks, Landmark, Current Care, etc.) electronic and other

resources to attach to submission.

• Create, update, and/or change prior authorization at provider request.
• Fax clinical notes to insurer when prior authorizations are initiated for patients from another facility.
• Monitor queues for prior authorization approval letters then faxes or calls rendering

facility, pharmacy, and/or patient with approval information.

• Monitor faxes for pharmacy denials and reviews patient records and/or contacts patient to

verify list of failed medications, checks plan formulary, confers with THC pharmacist or

pharmacy for alternatives for provider approval/denial.

• Inform provider/prescriber of denials to determine if an appeal should be submitted and

submit appeal if determined appropriate with all accompanying documentation.

• Prepare responses to authorization denials within an appropriate timeframe.
• Monitor eCW to verify fax confirmations; resend failed faxes.
• For patients with Medicare Part D, contact plan or pharmacy to verify the correct plan and

ID number.

• Close duplicates and completes process in an open request.
• Follow standardized workflows to enable continuity and cross coverage.

Physical Effort/ Environment:

• This role is a hybrid position, allowing duties to be performed from home or at a Thundermist site.
• Organizational skills; phone, fax, copier, scanner, computer, writing, and typing.
• Moderate physical activity, walking, standing, stooping, and occasional lifting.

Work Schedule Demands:

• This is a full-time position, working 40 hours a week.

Communication Skills:

• Communication with patients, providers, and colleagues on a daily basis.

Confidentiality of Information:

Thundermist is dedicated in securing the privacy and confidentiality of protected health information under the Health Insurance Portability and Accountability Act. It is the responsibility of all employees to comply to state and federal guidelines in accessing sensitive information. Additionally, this role will have access to sensitive agency information. The incumbent must apply strict confidentiality.

ADA & EEOC Statement:

Thundermist is dedicated to the goal of building and maintaining a diverse and inclusive workforce committed to caring for patients in a manner that is respectful of cultural difference. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity, national origin, disability status, protected veteran status, or any other characteristic protected by law.