Atrius Health, an innovative healthcare leader, delivers an effective system of connected care for more than 690,000 adult and pediatric patients at 30 medical practice locations in eastern Massachusetts. Atrius Health’s 645 physicians and primary care providers, along with 420 additional clinicians, work in close collaboration with hospital partners, community specialists and skilled nursing facilities. Our vision is to transform care to improve lives. Atrius Health provides high-quality, patient-centered, coordinated, cost effective care to every patient we serve. By establishing a solid foundation of shared decision making, understanding and trust with each of its patients, Atrius Health enhances their health and enriches their lives. Atrius Health is part of Optum, a health services company focused on building the leading value-based care system in the country.

SUMMARY

Reporting to and working under the general direction of the Supervisor(s) and Manager of the department, research patients' individual medical benefits to ensure prior authorization is obtained before patients' medical services are provided. Maintains the management of three separate medication referral Workqueues (New Requests, Pending Authorization, and Expired Authorizations) for multiple medications for various specialty departments. Manages authorizations by date of patients’ appointment, change of insurance or expiring authorizations.

Interacts directly with the payers’ authorization systems to ensure that prior authorization rules by the payor are adhered to and are accurately documented. Obtaining prior authorization guarantees Atrius Health can bill accurately for services where medication was administered in a timely manner.

Has extensive contact with patients, insurance payers, ordering providers, clinical support staff and site representatives to provide excellent customer service in the creation of prior authorizations.

EDUCATION/LICENSES/CERTIFICATIONS

High School diploma or equivalency certificate (e.g. GED, HiSET, TASC Test) from an accredited institution or governmental unit required.

EXPERIENCE

A minimum of three years in a clinical or customer service setting preferred. Must be able to respond knowledgeably to a wide range of patient issues for every contracted and non contracted payers, including government and non-government payers. Strong technical proficiency in Microsoft, scheduling software and electronic medical records systems (Epic or equivalent). Strong problem solving and complex patient management skills preferred. Relevant experience in the managed care environment preferred. High level of understanding of health insurance products and limitations in order to match patient to available providers.

SKILLS

Proven excellent customer service and communication skills. Ability to work under pressure and deadlines. Ability to execute assignments in a tightly scheduled production-oriented environment. Ability to exercise judgment in interpreting information. Detail oriented. General understanding of medical practice groups and payors. Proven aptitude with personal computers.

Atrius Health is committed to a policy of non-discrimination and equal employment opportunity. All patients, employees, applicants, and other constituents of Atrius Health will be treated with respect and dignity regardless of race, national origin, gender, age, religion, disability, veteran status, marital/domestic partner status, parental status, sexual orientation and gender identity and/or expression, or other dimensions of diversity.

BENEFITS INCLUDE:

· Up to 8% company retirement contribution

· Generous Paid Time Off

· 10 paid holidays

· Paid professional development

· Generous health and welfare benefit package

Atrius Health is an equal opportunity/affirmative action employer and does not discriminate in recruiting, hiring, training, promoting or any other employment practices on the basis of race, color, religion, sex, marital status, age, sexual orientation, gender identity, national origin, military service or application for military service, veteran or disability status.

Applicants have rights under Federal Employment Laws: Family and Medical Leave Act (FMLA);Equal Employment Opportunity (EEO); and Employee Polygraph Protection Act (EPPA).

VEVRAA Federal Contractor

Request Priority Protected Veteran & Disabled Referrals for all of our locations within the state