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Related keywords
- REFERRAL CARE COORDINATOR
- AUTHORIZATION COORDINATOR
- Referral Coordinator
- Prior Authorization Coordinator
- Referral Admissions Coordinator
- Provider Referral Coordinator
- Clinical Referral Coordinator
- Referral Relations Care Coordinator
- Referral Authorization Coordinator
- Insurance Referral Authorization Coordinator
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Referral & Authorization Care Coordinator
Company | Oshi Health |
Address | Miami, FL, United States |
Employment type | FULL_TIME |
Salary | |
Category | Internet Publishing |
Expires | 2023-06-03 |
Posted at | 1 year ago |
Oshi Health – Clinical Operations Care Coordinator: Prior Authorizations & Referrals
- Manage key reports and track relevant data to identify successes and drive refinements in operational processes.
- Engage in external coordination of pharmacy support services to ensure members receive all necessary support services available throughout the prior authorization process
- Assist members in accessing services, providing personalized customized customer service and support while maintaining close communication with members of the care coordination team.
- Ensure comprehensive communication and expectations are explained to the member throughout the referral and authorization process
- Collaborate with a multidisciplinary team of care providers (including MDs, NPs, RDs, Behavioral Health Providers, and Health Coaches) to provide a whole-person approach to member care.
- Initiate appeals for denied authorizations and maintain close follow up to ensure positive member outcomes
- Offer proficient knowledge of referrals, insurance requirements and the prior authorization process to internal and external resources, to eliminate barriers to care execution and provide follow up on progress toward meeting key goals.
- Responsible for the coordination, tracking and communication of patient referrals, prior authorizations, and medical records to promote team awareness and patient safety
- Provide complete and accurate registration of referrals and authorizations including patient demographics, current insurance information and clinical documentation to external providers and specialty pharmacies
- Partner with the Clinical Operations leadership team to define and help iterate on strategies for member care coordination
- Apply knowledge of CPT and ICD-10 codes to obtain authorizations in a timely manner while demonstrating understanding of payer medical policy guidelines
- Prioritize incoming referral, medical record requests, and authorization requests according to urgency
- Openness and ability to cross-train in additional care coordination tasks and responsibilities to support full cycle member engagement
- Completed a degree in a health and science related field, i.e. biology, psychology, health science and nutrition, nursing, etc
- Excellent verbal and written communication skills required.
- Ability to provide occasional weekend coverage required.
- Fluent in healthcare terminology or working understanding of clinical concepts.
- Background knowledge in navigating health insurance plans and coverage on the part of patients. Must be able to provide breakdown of benefits analysis to consumers.
- Excellent customer service qualities required.
- Needs to be able to work in a cross-functional interdisciplinary modality and effectively create solutions for complicated patient concerns.
- Must be able to work Monday through Friday 10am - 6pm EST with ability to work at minimal 2 weekend days per month.
- Minimum of 2-3 years experience working in a healthcare coordination, care or case management role, preferably in a digital healthcare environment
- Comfortable and competent with using common administrative technologies (e.g. Zoom, Slack, Office or equivalent), charting electronically in EMR/EHR systems , experience delivering on telehealth platforms preferred.
- Operate with high integrity and accountability for results
- Well organized, ability to manage multiple projects at once, eye for details, and collaborate within and across teams
- Must be result-oriented, a quick learner and self-starter
- Thrive in entrepreneurial environment, comfortable with ambiguity, and confident in making decisions
- Ability to roll up your sleeves to get things done yourself, as well as work in a cross-functional team environment
- Ability to solve problems, think outside-the-box, and be resourceful
- Thrive on diversity with monthly DEIB discussions, activities, and more
- Mission-driven organization focused on innovative digestive care
- Virtual-first culture: Work from home anywhere in the US
- Live our core values: Own the outcome, Do the right thing, Be direct and open, Learn and improve, Team, Thrive on diversity
- Access to a “Life Concierge” through Overalls, because we know life happens
- Employer-sponsored medical, dental and vision plans
- Competitive compensation with a starting pay range of $45,000-$52,000
- Tailored professional development opportunities to learn and grow
- 13 paid company holidays to power down
- Recognition of professional and personal accomplishments
- Team events, such as virtual cooking classes, games, and more
- Unlimited paid time off — take what you need, when you need it
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