Patient Care and Prior Authorization Coordinator

POSITION TITLE: Patient Care and Prior Authorization Coordinator

STATUS: Full Time, Non Exempt 

PAY RATE: Starting at $22 per hour

LOCATION: Remote

TRAVEL REQUIREMENTS: Approximately 20% travel within Michigan

BENEFITS: Medical, Dental, Vision, STD, LTD. Life & ADD, 403B, Flexible Spending Account, Generous Paid Time off Program and Free healthcare at our clinics for you and your immediate family!

Planned Parenthood of Michigan has implemented a mandatory vaccination policy requiring COVID-19 vaccinations including boosters when eligible for all employees.

Position Description

Under the supervision of the Clinical Follow-up Manager and Gender Affirming Care Program Manager, with clinical guidance from licensed staff and Medical Directors, this individual will participate in the patient follow-up and tracking systems in support of efforts to improve clinical outcomes of designated health indicators, and follow organizational protocols to complete tasks including infection reporting, medical records requests, patient communication, and scheduling appointments, and will take the lead role in prior authorization management for PPMI, including submissions, appeals and managing denials. This information will work closely with the Gender-Affirming Care team and patients receiving gender-affirming hormone care through PPMI–working to ensure prior authorization requests are accurate and comprehensive to optimize access to critical medications. This staff person will fully embody a commitment to race equity; evidenced in all interactions with PPMI colleagues and external stakeholders.

Essential Functions:

·       Collaborate with a multi-disciplinary team to:

o   Perform mandatory Sexually Transmitted Infection (STI) reporting to Michigan Department of Health.

o   Prepare care reminders by MyChart and mail.

o   Assist Centralized Follow Up RNs with medical records requests, patient communication and call coordination

o   Schedule appointments

o   Complete accurate and timely documentation in the medical record.

o   Perform medication prior authorization tasks and related patient communication.

o   Proactively manages prior authorization appeals and denials by speaking directly with insurance companies, pharmacies, etc.

·       Perform all tasks according to Medical Standards and Guidelines as well as relevant HIPAA, CLIA, OSHA, OLC and other regulatory requirements, including infection control standards and security guidelines

·       Ensure timely and appropriate processing and review of lab results and associated reporting to state agencies

·       Use follow-up and alert systems to perform timely patient follow-up for abnormal lab results, medication abortion patients, referrals, et.

·       Maintain systems to track and report outcomes and trends

·       Assist clinicians and RNs with patient communication to provide results and educate about treatment plans, referrals and available resources

·       Coordinates continuity of patient care with external healthcare organizations and facilities to specialty care providers; ensure timely provision and receipt of records. Manage processing/transfer of medical records as necessary to facilitate timely patient care.

·       Initiates, submits, tracks and closes out prior authorization requests across the affiliate; much of this work relates to prior authorizations for gender-affirming hormone medications, but includes non-gender-affirming medications.

·       Lead role in navigating difficult prior authorizations, denials and appeals, including obtaining and submitting letters of support in coordination with clinicians and the medical directors. This includes communication directly with patients, providers, insurance companies, and pharmacies.

·       Serves as a point person for unforeseen issues arising at the pharmacy, or in obtaining hormones and related supplies. May support efforts of the affiliate related to direct to patient medication and supply preparation and dispensing.

·       Communicates with patients via phone calls and portal messages related to prior authorizations, health care navigation, prescriptions, resources, support, etc.

·       Coordinates continuity of patient care with external health care organizations, facilities, and specialty care providers. Manages processing/transfer of medical records as necessary to facilitate timely patient care.

·       Participates in affiliate training programs by attending scheduled group trainings and meetings, reading and integrating assigned written materials, and completing individual CAL (e-learning) modules as required; assist in efforts to train new staff as necessary.

·       Participate in QRM program/committee work as needed, to include the performance of medical chart and medical log audits.

·       Participates in efforts to achieve customer service, productivity, and revenue goals; demonstrates commitment to affiliate’s values of patient-centered care, team approach to work and consistent regulatory compliance/inspection readiness.

·       If bilingual, provide translation as needed to clients and other staff.

·       Perform other duties as assigned, needed and required.

The above duties and responsibilities are not an exhaustive list of required responsibilities, duties and skills. Other duties may be added, and this job description can be amended at any time.

Skills and Qualifications:

Required

·       High school diploma or GED

·       Two or more years’ experience in a health center, FQHC or non-profit health care or ambulatory/outpatient medical office.

·       Excellent customer service skills. Commitment to caring for people of diverse backgrounds, cultures, and lifestyles, in a manner that engages ongoing self-reflection, humility, and continual learning required.

·       Organized, efficient, and able to follow instructions. Demonstrate proficiency in medical terminology, EHR systems, specifically Epic and Microsoft Office.

·       Commitment to supporting gender-affirming care, and the needs of gender diverse people.

·       Demonstrated ability to achieve objectives in collaboration with other functional areas

·       Demonstrated commitment to Planned Parenthood’s mission, vision and values

Preferred

·       Basic knowledge of medications used for gender-affirming hormone care, and challenges gender diverse people face in obtaining gender-affirming care.

 Ability to:

o   Strong ability to manage clinically and emotionally challenging situations with utmost professionalism, care and discretion.

o   Work independently with minimal supervision, as well as collaborate with a care team, while demonstrating exceptional organization, attention to detail, and follow-through.

o   Ensure protection of patients’ privacy and Protected Health Information (PHI) in a home office environment. Reliable wi-fi.

o   Work under pressure on multiple projects concurrently and meet deadlines in a fast-paced work environment with frequent interruptions and changing priorities.

o   Communicate effectively, both verbally and in writing.

o   Lead and work in a remote environment.

o   Handle stressful situations and provide a high level of customer service in a calm and professional manner.

o   Establish and maintain effective working relationships.

o   Travel and accept a flexible work schedule that may involve some evening and weekend commitments.

o   Solve problems, analyze information and data, and manage projects.

o   Exercise a high degree of judgment and diplomacy and maintain confidentiality.

Key Requirements

·       Commitment to advancing race(+) equity in one's work: interest in expanding knowledge about the role that racial inequity plays in our society.

·       Awareness of multiple group identities and their dynamics; bring a high level of self-awareness about personal identity, empathy, and humility to interpersonal interactions.

·       Demonstrated ability to communicate clearly and directly as well as hear and act on feedback related to identity and equity.

·       Strong sense of accountability to diversity, equity and inclusion principles and practices.

·       Understand the impact of identity dynamics on organizational culture.

·       Commitment to Planned Parenthood's In This Together service ethos, workplace values, and service standards.

We value a truly diverse workforce and a culture of inclusivity and belonging. Our goal is to attract qualified candidates and encourage applications from all individuals without regard to race, color, religion, sex, national origin, age, disability, veteran status, marital status, sexual orientation, gender identity, or any other characteristic protected by applicable law.  We're committed to creating a dynamic work environment that values diversity and inclusion, respect and integrity, customer focus, and innovation.