Description

Providence is calling an Associate Health Care Services Technician: Prior Authorizations who will:

• Be responsible for providing quality service to Health Care Services (HCS) customers in one or more of the core functional areas including, care management, concurrent review, prior authorization, appeals, claims, provider reconsiderations, medical audit and/or training
• Be responsible for accuracy, integrity, and confidentiality of information received, processed, and subsequent communication of that information to required parties

We welcome 100% remote work for residents who reside in Portland, OR and Vancouver, WA.

Primary Responsibilities:

• Independently coordinates and processes medical prior authorizations, taking into consideration medical benefits, medical policies, documented technician approval criteria, and information submitted by provider
• Triages and documents incoming calls and requests, identifies and obtains resources for those requiring immediate attention and handles these through established protocols utilizing appropriate level of assessment and judgment
• Routes work to other resources as deemed appropriate
• Monitors, retrieves, and prioritizes incoming work as required
• Performs intake and system data entry of information such as authorization and referral requests, patient information, and discharge information
• Uses sound judgment in identifying the need for clinical review or nurse/physician intervention by routing to appropriate licensed staff based on guidelines and established protocols/procedures
• Maintains the accuracy and integrity of the database and all confidential medical record information received and purges medical records as required according to established protocols
• Acts as department liaison and resource to members, Health Plan providers, and Health Plan departments to problem solve or address inquiries regarding work, workflow, processes, information system issues and relationships
• Educates and assists provider and office staff, members and payers, operations department and other Health Plan employees in Medical Management and Case Management processes and system usage as applicable
• Serves as knowledge holder of HCS department duties within the health plan and serves as a consultant as needed and within scope of position
• Maintains sound working knowledge of all relevant Providence and department policies and procedures
• Understands and is able to effectively use all PHP resources including but not limited to medical policy criteria, prior authorization lists, KMS and established policies and procedures
• Maintains a thorough knowledge of utilization management and cost containment strategies, member and providers contracts, utilization management and case management programs, imaging and workflow systems and personal computer applications

Required qualifications for this position include:

• Experience and a proven track record of learning and applying complex concepts
• Experience in database management and spreadsheets
• Experience with telephone systems, call center phone volumes and multi-line communication systems

Preferred qualifications for this position include:

• Bachelor's Degree in a Health related field -OR- a combination of equivalent education / experience
• Experience in utilization management or care management, such as medical review, claims audit, appeals, delegation, or quality/credentialing
• 3 years experience in a health related field

Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.

About Providence

At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.

The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Check out our benefits page for more information about our Benefits and Rewards.

About the Team

Providence Shared Services is a service line within Providence that provides a variety of functional and system support services for our family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise.

We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment.

We are committed to cultural diversity and equal employment for all individuals. It is our policy to recruit, hire, promote, compensate, transfer, train, retain, terminate, and make all other employment-related decisions without regard to race, color, religious creed (including religious dress and grooming practices), national origin (including certain language use restrictions), ancestry, disability (mental and physical including HIV and AIDS), medical condition (including cancer and genetic characteristics), genetic information, marital status, age, sex (which includes pregnancy, childbirth, breastfeeding and related medical conditions), gender, gender identity, gender expression, sexual orientation, genetic information, and military and veteran status or any other applicable legally protected status. We will also provide reasonable accommodation to known physical or mental limitations of an otherwise qualified caregiver or applicant for employment, unless the accommodation would impose undue hardship on the operation of our business.

We are a community where all people, regardless of differences, are welcome, secure, and valued. We value respect, appreciation, collaboration, diversity, and a shared commitment to serving our communities. We expect that all workforce members in our community will act in ways which reflect a commitment to and accountability for, racial and social justice and equality in the workplace. As such, we will maintain a workplace free of discrimination and harassment based on any applicable legally protected status. We also expect that all workforce members will maintain a positive workplace free from any unacceptable conduct which creates an intimidating, hostile, or offensive work environment.

Requsition ID: 133864

Company: Providence Jobs

Job Category: Member Services Enrollment & Billing

Job Function: Health Plans Services

Job Schedule: Full time

Job Shift: Day

Career Track: Admin Support

Department: 5018 HCS MEDICAL MANAGEMENT OR REGION

Address: OR Beaverton 3601 SW Murray Blvd

Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.