Scheduling and Authorization Coordinator/Medical ...

Description The Scheduling and Authorization Coordinator and Medical Assistant is a key role within BestCare's Addiction Medicine Clinic (AMC) and supports all sites that provide addiction medication services, responsible for managing patient scheduling, obtaining necessary authorizations, and providing both front office and medical support. This role involves handling REMS (Risk Evaluation and Mitigation Strategy), medication ordering, scheduling, and deliveries, as well as assisting with prior authorization management and portal submissions. The ideal candidate will possess strong organizational skills, a thorough understanding of healthcare operations, and the ability to support both administrative and clinical functions. Essential Functions: Patient Scheduling: Coordinates and schedules patient appointments for all AMC sites, including evaluations, follow-ups, tests, and treatments; Verifies patient information, insurance details, and any specific requirements prior to scheduling; Communicates appointment details to patients and their families, ensuring they receive clear instructions and necessary information. Authorization Management: Obtains and manages pre-authorizations and referrals for various services at all AMC sites providing AMC services; Maintains up-to-date knowledge of insurance policies, coverage requirements, and authorization processes; Tracks, follows up on pending authorizations, and ensures timely approvals to minimize delays in patient care; Assists with managing and submitting prior authorizations through dedicated portals. REMS Medication Ordering and Scheduling: Orders REMS medications and coordinate their delivery for all AMC sites, ensuring compliance with regulatory requirements; Schedules and tracks REMS medication deliveries to ensure timely receipt and availability; Maintains accurate records of REMS medication orders and deliveries. Patient Communication: Serves as the primary contact for patients for rapid access, authorizations, REMS medications, referrals and insurance inquiries; Provides clear and accurate information about appointment logistics, insurance coverage, REMS medication requirements, and required documentation; Addresses and resolves concerns related to scheduling, authorizations, and medication deliveries. Coordination with Clinical Staff: Communicates any changes or updates in schedules and authorizations to clinical personnel at all AMC sites; Assists in preparing necessary documentation for patient appointments and procedures; Collaborates with clinical staff to coordinate patient schedules and ensure an efficient workflow. Front Office Duties: Provides front office support for the Bend or Redmond location, including check-in/check-out processes, handling phone calls, and managing patient records; Assists with medical tasks such as taking vital signs, preparing patients for examinations, and conducting basic lab tests; Ensures a welcoming and organized environment for patients. Documentation and Recordkeeping: Maintains accurate and organized records of patient appointments, authorizations, REMS medication orders, and communications; Ensures all patient information is updated in the electronic health record (EHR) system; Generates reports on scheduling, authorization, and REMS medication activities as required by management. Compliance and Quality Assurance: Ensures all scheduling, authorization, and REMS medication processes comply with organizational policies, insurance requirements, and regulatory standards; Participates in quality assurance activities to identify and implement improvements in scheduling, authorization, medication management, and patient care processes; Stays informed about changes in healthcare regulations, insurance policies, and best practices related to scheduling, authorizations, and REMS medications. ORGANIZATIONAL RESPONSIBILITIES: Performs work in alignment with the BestCare's mission, vision, values; Supports the organization's commitment to diversity, equity, and inclusion by fostering a culture of open-mindedness, cultural awareness, compassion, and respect for all individuals; Strives to meet Program/Department goals and supports the organization's strategic goals; Adheres to the organization's Code of Conduct, Business Ethics, Employee Handbook, and all other relevant policies, procedures, and other compliance needs; Understands and maintains professionalism and confidentiality per HIPAA, 42 CFR, and Oregon Statutes; Attends required program/staff meetings and completes assigned training timely and satisfactorily; Ensures that any required certifications and/or licenses are kept current and renewed timely; Works independently as well as participates as a positive, collaborative team member. Performs other organizational duties as needed. QUALIFICATIONS: EDUCATION AND/OR EXPERIENCE REQUIREMENTS: HSD (or equivalent) Must have previous experience as a Medical Assistant or Emergency Medical Technician Minimum of 1 year of experience in healthcare scheduling, insurance authorization, or a related administrative role and using an electronic health record (EHR) system and scheduling software LICENSES AND CERTIFICATIONS: Current Certified Medical Assistant, EMT, or LPN or ability/commitment to obtain within 1 year Current BLS certification or ability to obtain within 60 days of hiring Must maintain a valid Oregon Driver License or ability to obtain one upon hire, and be insurable under the organization's auto liability coverage policy (minimum 21 years of age and with no Type A violations in the past 3 years, or three (3) or more Type B violations) PREFERRED: Associates degree in healthcare administration or related field preferred Experience with REMS medication processes and prior authorization portals preferred Experience as a medical assistant or similar role in a healthcare setting is preferred Experience using OCHIN Epic a plus Bilingual in English/Spanish a plus REQUIRED COMPETENCIES: Must have demonstrated competency or ability to attain competency for each of the following within a reasonable period: Strong knowledge of medical terminology, healthcare operations and insurance processes Proficiency in using electronic health record (EHR) systems and scheduling software Strong knowledge of medical terminology, healthcare operations, and insurance processes Strong proficiency in MS Office 365 (Word, Excel, Outlook), MOTS, virtual meeting platforms, internet, and ability to learn new or updated software Excellent interpersonal and customer service skills and ability to apply these skills to engage with clients, family members, or community resources Ability to multitask, prioritize workload, and work effectively in a dynamic environment Excellent organizational and communication skills (oral and written) with attention to detail, accuracy and follow-through Critical thinking and problem-solving skills to collaborate with clinical and administrative staff Ability to show compassion towards individuals with mental health and substance abuse disorders within a culturally diverse community Ability to maintain strict confidence as required by HIPAA, 42 CFR, and Federal and State regulations Ability to work effectively and respectfully in a diverse, multi-cultural environment Ability to manage a multi-line phone professionally and efficiently, and take accurate phone messages to route timely to the appropriate person Ability to work independently as well as participating as a positive, collaborative team member. Ability to build and maintain trust and positive relationships with co-workers and other staff or community partners Ability to function well and use good judgment in a high-paced and at times stressful environment Ability to manage conflict resolution and anger/fear/hostility/violence of others appropriately and effectively TOOLS AND EQUIPMENT USED: Standard office equipment including computer/laptop, copy/fax/scanning machine, printer, telephone, and multi-line phone; Medical equipment including blood pressure cuff (digital and manual), pulse oximeter, digital thermometer, glucometers, venipuncture equipment, stethoscope, oxygen tanks and tubing, and in residential programs, C-PAP equipment. WORK ENVIRONMENT/PHYSICAL DEMANDS: The work environment is respectful, multi-cultural and inclusive, and the characteristics described above are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The position requires the employee to dress in a manner that meets the standards for professional attire at Best Care or per department- or job-specific requirements (See Dress Code Policy in Employee Handbook). Other working conditions/demands include: Primarily indoors (95%) Prolonged periods sitting at a desk and working on a computer/laptop, with occasional standing and walking Exerts force or lifts/carries up to 10-20 pounds at times Pushes/pulls 50-75 pounds occasionally Continuous use of arms, wrists, hands to perform repetitive tasks/motions Occasional grasping/squeezing and reaching above or below shoulder-level Must be able to hear alarms/telephone/audio/normal speaking voice Must have clarity of vision: Near ( 20" to 20') Must be able to drive motor vehicle to perform job May be exposed to communicable disease

Created: 2024-11-03