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Medical Assistant - Triage and Prior Authorization

Company: Mass Lung & Allergy PC
Location: Leominster
Posted on: May 7, 2022

Job Description:

Job DescriptionPOSITION SUMMARYAs a Triage / Prior Medication Prior Authorizations Medical Assistant at MASS LUNG & ALLERGY (MLA) this position performs a wide variety of duties and responsibilities in a manner that places emphasis on quality of care and customer service. The incumbent must work collaboratively with all staff in support of patient services, exhibiting flexibility and a "can-do" attitude. Patient services are the key priority in this position requiring the Triage / Prior Authorizations MA to serve as a point of contact with other internal and external departments, all with the goal of fostering an environment which promotes patient comfort and trust. The position must exemplify the core values and mission of the organization, always exercising utmost discretion, diplomacy and tact in patient/staff interactions.Stay for 180 days and earn a $600 retention bonus!DUTIES AND RESPONSIBILITIES:

  • Manage large amounts of calls in a timely manner.
  • Identify patient's needs, clarify information, research each issue, and provide solutions and/or alternatives.
  • Triage the patient's condition, by asking pertinent questions regarding the patient's current symptoms as outline in the triage sample questions of the training binder. Information should be recorded in a Telephone Encounter and relayed to the physician/provider for determination on course of action, or an appointment should be made for the patient if available.
  • Identify emergent situations and contact emergency services for patients as necessary.
  • Do not give medical advice to patients unless directed by the provider.
  • Relay provider instructions clearly to the patient.
  • Build sustainable relationships and engage patients.
  • Properly document all calls in eCW in a comprehensible way with attention to detail in grammar and punctuation.
  • Schedule appointments for new and recurring patients based on provider availability.
  • Provide patients with support and guidance as needed.
  • Assists Medical Assistants with "stat order" items to include Oxygen starts, and Neb orders.
  • Responsible for processing Medication Prior Authorizations via patient documents, Telephone encounters, and the cover my meds web site.
  • Follows the prior authorization to completion, communicating with the provider and patient with updates.
  • Provide samples as needed while PA is pending; making sure MD approves of samples.
  • Facilitates requests for lab work that may be needed for specific testing.
  • Obtains clinical rational when needed.
  • Schedules peer to peers with the provider when needed.
  • Assists with Specialty Pharmacy Prior AUTH's when needed.
  • Contacts patient to discuss alternative medications as well as the requirements and instructions from their insurance companies.
  • Contacts Pharmacies to discuss alternative medications as well as the requirements and instructions from the patient's insurance companies.
  • Assist with answering questions on Tier coverage.
  • Working knowledge of insurance policies regarding necessary requirements to obtaining a Prior Authorization (I.e., when the PA is needed vs making sure there is 120-day refill of the rescue inhaler).
  • Assist with scheduling follow-up appointments for patients in none in place at time of call to patient.QUALIFICATIONS:
    • Excellent communication and problem solving skills at a level necessary for understanding provider and supervisors instructions, and for accurately documenting patients' medical information.
    • Ability to effectively communicate with patient population and staff while demonstrating a high degree of diplomacy and tact.
    • Intermediate computing and phone skills.
    • Willingness to work past the end of shift to ensure patient care and safety; demonstrates flexibility in regards to job duties and assignments with a willingness to travel to necessary office locations.
    • Ability to multi-task and work effectively in a high-stress and fast-moving environment.
    • Culturally sensitive and demonstrated ability and effectiveness working with ethnically diverse populations.
    • Working knowledge of "Universal Precautions," demonstrates professionalism at all times.
    • Possess a thorough understanding of the importance of confidentiality and non-disclosure according to the general standards set forth by HIPAA.
    • Bilingual English/Spanish and/or other languages strongly preferred.
    • Valid Driver's License, insurance, and ability to travel as required to perform duties.EDUCATION AND EXPERIENCE:
      • High school Graduate (or GED) required.
      • Current, valid Certification of Medical Assistant through a nationally recognized accrediting agency such as the AAMA or RMA.
      • Current, valid CPR certification.
      • Familiarity with community / service area.
      • Previous experience as a Medical Assistant.
      • Electronic medical records experience preferred.

Keywords: Mass Lung & Allergy PC, Leominster , Medical Assistant - Triage and Prior Authorization, Healthcare , Leominster, Massachusetts

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