The final salary and offer components are subject to additional approvals based on Cook County Health (CCH) policy. Your placement within the salary range is dependent on a number of factors including your work experience and internal equity within this position classification at CCH. For positions that are represented by a labor union, placement within the salary range will be guided by the rules in the collective bargaining agreement.Location/Department: Bureau of Health/ Prior Authorization/Revenue CycleShift: 8:00AM – 4:00PMNon-UnionJob TitlePrior Authorization Medication Access CoordinatorDepartmentFinance/Revenue CycleThis position is exempt from Career Service under the CCH Personnel Rules.Job SummaryThe Prior Authorization Medication Access Coordinator (PA MAC) will serve as the primary liaison for ACHN clinics with regard to pharmacy based prior authorizations. The PA MAC is responsible for actively supporting the execution of strategic initiatives process re-design root cause analysis metric/report development and special projects as it relates to authorization denials. The PA MAC will serve as a primary resource on prior authorization requirements.Typical Duties
Review and process prior authorization request for medications in the ACHN clinics.
Verify insurance coverage and ensure all necessary documentation is completed.
Communicate with medical staff, insurance companies, and specialty pharmacies regarding authorization status.
Maintain accurate records of authorizations and follow-up as needed.
Collaborate with medical staff to ensure compliance with policies and procedures.
Observe and understand prescribing trends within ambulatory clinics.
Ensure patients receive the services that require prior authorization from insurance carriers by addressing and rectifying rejected claims that require additional documentation and/or Peer to Peer Consultation.
Assist in resolving any authorization related issues or denials.
Maintains an audit trail of changes to authorization requirements to assist with root cause analysis and support cause of appeals.
Analyzes the prior authorization denial report to identify reasons for denials and recommends workflow adjustments as needed, collaborating with affected departments on any workflow or system build issues.
Maintains a current knowledge related to insurance changes and requirements for prior authorization.
Improve patient service experience.
Attends and participates in meetings, as needed.
Performs other duties as assigned by the Director of Pre-Patient Access.
QualificationsMinimum Qualifications
Licensed as a medical professional in the state of Illinois with two (2) years of experience of prior authorization experience/utilization management, required
ORBachelor’s degree from an accredited college or university with one (1) year of experience prior authorization experience/utilization management, is required (must provide official transcripts at time of interview)
Two (2) years of relevant medication prior authorization experience, required
One (1) year experience with electronic medical records (EMR), required
Prior experience working in a physician group, insurance company or management services organization, required
Preferred Qualifications
Bachelor’s degree in nursing, Health Science, Business or related field from an accredited college or university, is preferred, (must provide official transcripts at time of interview)
Experience in claims adjudication, preferred
Care management or medical insurance experience, preferred
Prior experience using InterQual or Milliman criteria sets, preferred
Knowledge, Skills, Abilities and Other Characteristics
Excellent verbal, written communication, and interpersonal skills necessary to communicate with all levels of staff and a patient population composed of diverse cultures and age groups
Knowledge and proficiency with Microsoft applications and internet-based programs
Strong interpersonal skills with the ability to establish strong working relationships
Strong time management skills to prioritize assignments and meet the designated deadlines
Ability to anticipate, recognize, and meet the needs of patients and families
Ability to work in a team-based environment to accomplish goals and objectives
Ability to demonstrate respect and sensitivity for cultural diversity in CCH work force and patient population
Ability to critically think, problem solve and make independent decisions supporting the authorization process, including interactions with payer representative, physicians, and hospital case managers
Physical and Environmental DemandsThis position is functioning within a healthcare environment. The incumbent is responsible for adherence to all hospital and department specific safety requirements. This includes but is not limited to the following policies and procedures: complying with Personal Protective Equipment requirements, hand washing and sanitizing practices, complying with department specific engineering and work practice controls and any other work area safety precautions as specified by hospital wide policy and departmental procedures.The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of the personnel so classified.For purposes of the American with Disabilities Act, “Typical Duties” are essential job functions.VETERAN PREFERENCEWhen applying for employment with Cook County Health & Hospitals System preference is given to honorably discharged Veterans who have served in the Armed Forces of the United States for not less than 6 months of continuous service, who was not dishonorably discharged.To take advantage of this preference a Veteran must:MEET THE MINIMUM QUALIFICATIONS FOR THE POSITION.· IDENTIFY AS A VETERAN ON THE EMPLOYMENT APPLICATION BY ANSWERING YES TO THE QUESTION “Are you a Military Veteran?”· ATTACH A COPY OF THE VETERANS DD214, DD215 or NGB 22(NOTICE OF SEPARATION) AT TIME OF APPLICATION FILING.PLEASE NOTE: IF YOU HAVE MULTIPLE DD 214S, 215S, OR NGB 22S, PLEASE SUBMIT THE ONE WITH THE LATEST DATE. COAST GUARD MUST SUBMIT A CERTIFIED COPY OF THE MILITARY SEPARATION FROM EITHER THE DEPARTMENT OF TRANSPORTATION (BEFORE 911) OR THE DEPARTMENT OF HOMELAND SECURITY (AFTER 911).VETERANS MUST PROVIDE ORIGINAL APPLICABLE DISCHARGE PAPERS AT TIME OF INTERVIEW.Benefits Package
Medical, Dental, and Vision Coverage
Basic Term Life Insurance
Pension Plan and Deferred Compensation Program
Employee Assistance Program
Paid Holidays, Vacation, and Sick Time
You may also qualify for the Public Service Loan Forgiveness Program (PSLF)
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