Clinical Documentation and Authorization Specialist (Medical Assistant)

CURRENT HOLLAND HOSPITAL EMPLOYEES- Please apply through Find Jobs from your Workday employee account.

Provides coverage for duties relative to a centralized document and authorization system. Supports individual offices to ensure accuracy of information for incoming documents. Supports individual offices by updating medical records with pertinent information i.e. lab results, historical information.

Pay Range: $18.50 - 23.64/hour

Employment Type: Full Time, 72 hours every 2 weeks.

Schedule: Mon, Tues, Wed, Fri 8am-5:30pm, no weekends or holidays.

Requirements: High School Diploma/GED required, Current Medical Assistant Certification or Registration or LPN required, BLS for the Healthcare Provider 60 days after hire required.

Communication Customer Service

• Communicates professional and effectively with patients (or families when appropriate), internal customers, insurance payers, practice managers and multi-disciplinary team of providers.

• Understands essential role in patient care coordination

• Anticipates and provides support to clinical teams so they can focus on medical office productivity

• Assures messages, forms, documentation are handled in a timely manner

• Communicates through a variety of methods including verbal, written, electronic

• Ability to prioritize messages, forms and documents

Document Management

• Timely retrieval and delivery of fax inbox documents

• Accurately assign patient documents to appropriate patient, folder, and naming convention guidelines

• Compliant with patient confidentiality/HIPAA regulations

• Updates medical record with pertinent historical medical information

• Completes refill requests accurately for providers by reviewing current information, creating a telephone encounter and forwarding to provider.

Prior Authorization

• Review and complete prior authorization requests for medications and high tech imaging

• Understand insurance coverage criteria and prior authorization requirements and stay up to date with  changes

• Proactively communicate with providers to gather supporting documentation for authorizations

• Track and monitor the status of all active prior authorizations and ensure timely submission of necessary documentation

• Educate patients on prior authorization process and address questions/concerns without the scope of license forwarding to provider or pharmacist as needed

QUALITY IMPROVEMENT

• Supports the quality improvement activities of the practices and understands role in quality improvement initiatives.

• Participates in learning experiences as appropriate.

• Ensures compliance with Organizations Quality Improvement program.

• Maintains and closes work flow process relative to referrals, authorizations, and orders to satisfy quality improvement initiatives.

Holland Hospital is an Equal Opportunity Employer, please see our EEO policy