Care Coordinator- Prior Authorization

We will not be accepting any applications from the following areas: California, New York, Wyoming, Colorado, Minnesota, Michigan, New Jersey, Illinois, Massachusetts, Washington, Maryland, DC, Montana, Iowa, Pennsylvania, Oregon, Connecticut, South Dakota, Nevada, Alaska and Hawaii. 

 

***Schedule is Monday- Friday 12-8pm EST Only***

 

We are seeking a Care Coordinator that specializes in back office responsibilities including but not limited to referral management, prior authorizations, specialty pharmacy & infusions, and medical records to help deliver and implement clinical strategies and assist in member care coordination in collaboration with a multidisciplinary clinical team. As a core member of the clinical team, you will utilize a high level of attention to detail, organization, and communication skills to help obtain, manage, and follow up on member referrals and prior authorizations to ensure key care plan goals are met. A strong ability to manage multiple priorities, knowledge of CPT and ICD-10 codes and proficiency in navigating the prior authorization process will contribute to positive member outcomes of safe and highly efficient care delivery. You will have access to ongoing training and support from a GI focused team to help you develop an expertise with digestive health conditions.

What you’ll do?

• Collaborate with a multidisciplinary team of care providers (including MDs, NPs, RDs, Behavioral Health Providers, and Health Coaches) to provide a whole-person approach to member care.
• Responsible for the coordination, tracking and communication of patient referrals, prior authorizations, and medical records to promote team awareness and patient safety
• Ensure comprehensive communication and expectations are explained to the member throughout the referral and authorization process
• Provide complete and accurate registration of referrals and authorizations including patient demographics, current insurance information and clinical documentation to external providers and specialty pharmacies 
• Offer proficient knowledge of referrals, insurance requirements and the prior authorization process to internal and external resources, to eliminate barriers to care execution and provide follow up on progress toward meeting key goals.
• Prioritize incoming referral, medical record requests, and authorization requests according to urgency
• Apply knowledge of CPT and ICD-10 codes to obtain authorizations in a timely manner while demonstrating understanding of payer medical policy guidelines
• Initiate appeals for denied authorizations and maintain close follow up to ensure positive member outcomes
• Engage in external coordination of pharmacy support services to ensure members receive all necessary support services available throughout the prior authorization process 
• Assist members in accessing services, providing personalized customized customer service and support while maintaining close communication with members of the care coordination team.
• Manage key reports and track relevant data to identify successes and drive refinements in operational processes.
• Openness and ability to cross-train in additional care coordination tasks and responsibilities to support full cycle member engagement
• Partner with the Clinical Operations leadership team to define and help iterate on strategies for member care coordination

Who You Are?

• Minimum of 2-3 years experience working in a healthcare coordination, care or case management role, preferably in a digital healthcare environment.
• Must be able to work Monday through Friday 12pm - 8pm EST. 
• Fluent in healthcare terminology or working understanding of clinical concepts.
• Background knowledge in navigating health insurance plans and coverage on the part of patients. Must be able to provide breakdown of benefits analysis to consumers. 
• Ability to work in a cross-functional interdisciplinary modality and effectively create solutions for complicated patient concerns.
• Comfortable and competent with using common administrative technologies (e.g. Zoom, Slack, Office or equivalent), charting electronically in EMR/EHR systems , experience delivering on telehealth platforms preferred.
• Excellent verbal and written communication skills required.
• Excellent customer service qualities required.
• Ability to provide occasional weekend coverage required. 
• Have a dedicated, quite working space that is free from distraction and reliable, high speed internet access.
• Completed a degree in a health and science related field, i.e. biology, psychology, health science and nutrition, nursing, etc. preferred

What you'll bring to the team?

• Ability to solve problems, think outside-the-box, and be resourceful
• Must be result-oriented, a quick learner and self-starter
• Ability to roll up your sleeves to get things done yourself, as well as work in a cross-functional team environment
• Well organized, ability to manage multiple projects at once, eye for details, and collaborate within and across teams
• Thrive in entrepreneurial environment, comfortable with ambiguity, and confident in making decisions
• Operate with high integrity and accountability for results

Why Work At Oshi?

We’re revolutionizing GI care — and our employees are driving the change. We’re a hard-working and fun-loving team, committed to always learning and improving, and dedicated to doing the right thing for our members. To achieve our mission, we invest in our people:

We make healthcare more equitable and accessible:

• Mission-driven organization focused on innovative digestive care
• Thrive on diversity with monthly D&I discussions, activities, and more
• Virtual-first culture: Work from home anywhere in the US
• Live our core values: Own the outcome, Do the right thing, Be direct and open, Learn and improve, Team, Thrive on diversity 

We take care of our people:

• Competitive compensation with a starting pay range of $45,000-$52,000
• Work from home stipend
• Employer-sponsored medical, dental and vision plans 
• Access to a “Life Concierge” through Overalls, because we know life happens
• Tailored professional development opportunities to learn and grow

We rest, recharge and re-energize:

• Flexible paid time off
• Paid company holidays to power down
• Team events, such as virtual cooking classes, games, and more
• Recognition of professional and personal accomplishments