Manager, Message InBasket Support, Pharmacy

Sutter Health•Los Altos, CA

About The Position

Accountable for ensuring accurate and timely completion of all referrals and authorizations and acts as a resource to providers, clinical operations, and staff. Maintains department metrics and ensures that established turnaround times are adhered to. Works daily to evaluate referral volume, patient call volumes and distributes workload accordingly. Responsible for creating and maintaining workflows and documentation for the following: verifying patient eligibility, coordination of benefits, ensuring accurate insurance coverage, and determining if prior authorization is needed for physician orders. Investigates and responds to patient and provider escalations regarding inquiries and referrals not meeting turnaround standards.

Requirements

8 years recent relevant experience
Knowledge of insurances and authorization processes.
Familiarity with government billing regulations, including The Health Care Finance Administration (HCFA), Medicare, and Medi-Cal/Medicaid.
Medical Terminology
Familiarity of state and federal laws regarding Health Insurance Portability and Accountability Act (HIPAA).
Knowledge of Microsoft Office Suite, including but not limited to Excel, Word and Power Point proficiency.
Ability to effectively utilize consultative skills and maintain interpersonal relationships with the department and at all levels of the organization.
Well-developed phone and customer service skills including the ability to professionally, calmly, and effectively work with all customers, including the ability to de-escalate patient and/or provider escalations.
Organizational and time management skills, with the ability to prioritize multiple projects while delivering quality service and achieving business results.
Medical terminology, Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS)/International Classification of Diseases (ICD)-9 coding knowledge.

Nice To Haves

Pharmacy experience strongly preferred
Bachelor's: Business, Finance, Computer Science or related field
Equivalent experience will be accepted in lieu of the required degree or diploma.

Responsibilities

Ensuring accurate and timely completion of all referrals and authorizations.
Acting as a resource to providers, clinical operations, and staff.
Maintaining department metrics and ensuring established turnaround times are adhered to.
Evaluating referral volume, patient call volumes and distributing workload accordingly.
Creating and maintaining workflows and documentation for verifying patient eligibility, coordination of benefits, ensuring accurate insurance coverage, and determining if prior authorization is needed for physician orders.
Investigating and responding to patient and provider escalations regarding inquiries and referrals not meeting turnaround standards.