Job Description

Job Description

Job Description

Duties and Responsibilities

Primary Job Functions:

• Responsible for reviewing, submitting, monitoring, and responding to issues regarding medication prior authorizations.

• Reviews patient medical history to identify supporting documentation in the patient chart relevant to the medication.

• Professionally communicates with prescribers, practice support staff, patients, and representatives of insurance companies; includes oral and written communication.

• Responsible for contacting insurance companies via appropriate method to obtain prior authorization.

• Updates information in the patient medical record with approval or declination information; follows up with ordering physician as to status of prior authorization.

• Efficiently tracks pending authorizations for multiple offices/prescribers.

• Creates a positive, professional, service-oriented work environment for staff, patients, and family members by supporting the mission and values of OGG.

Secondary Job Functions:

• Attends required meetings and training as requested.

• Maintain confidentiality of patient and financial information by utilizing HIPPA guidelines and regulations.

• Adheres to all Federal, State, and Local laws and regulations as well as policies set forth by Ohio Gastroenterology Group Inc, and its related parties.

Knowledge, Skills, and Abilities

• Knowledge of third-party payers and prior authorization requirements

• Understanding of basic medical terminology and medications

• Proficient use of office equipment, such as copier, fax machine, phones, etc.

• Intermediate computer skills including use of Microsoft Office (Excel and Word), electronic mail, payer websites, physician practice management, and electronic medical record systems.

• Strong time management skills

• Ability to work independently with minimal supervision and to manage multiple priorities.

• Strong written and verbal communication skills

• Ability to effectively communicate with a variety of individuals.

• Neat appearance, professional demeanor, and pleasant voice

• Fluent in English

Credentials and Experience

• Must have a high school diploma or equivalent.

• One (1) year of experience and relevant knowledge of insurance eligibility or prior authorization in a healthcare setting preferred.

• Certified pharmacy technician, certified medical assistant, or licensed practical nurse preferred.

Work Environment

• Minimal medical office exposure that may require contact with adult patients

• Office workstation environment with numerous employees

Ohio Gastroenterology Group offers a nice life/work balance and a great benefits package that includes:

• Medical, dental and vision coverage- benefits are effective the first of the month following 30 days of employment

• Company paid life insurance and short term disability 

• Generous paid time off plans (vacation, sick and personal)

• 7 paid holidays

• Two retirements plans:

• 401(k) plan that offers a 3% safe harbor contribution with immediate vesting as well as annual profit sharing contributions.

• Cash balance pension plan – company contributes 2.5% and offers full vesting after 3 years of employment.

• Tuition reimbursement programs

• Employee appreciation programs

• Uniform reimbursement programs 

• Growth opportunities

• Learning and development training 

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