Sr Patient Admin Coordinator - Boston Children's Hospital

The Sr. Patient Administrative Coordinator coordinates and facilitates administrative processes and services at a center or program necessary to deliver and support the care for patients with chronic disease. Serves as the center or program’s point person for managing the prior authorization process for treatments involving specialized medicines and medical procedures across providers in multiple specialties. They are also responsible for communications and services with insurance companies, medical device and supply companies, and specialty pharmacy companies in support of providers’ care. They also provide training and guidance to center/program staff on related administrative processes and procedures.

The Sr. Patient Administrative Coordinator will:

• Manage the authorization process for a significant variety of medicines, specialized treatments, medical procedures, etc. for patients across multiple providers and specialties.
• Prepare letters of medical necessity based on physician’s notes.
• Under supervision, coordinates with insurance companies, specialty pharmacies and patient’s families for the delivery of the specialized treatments during clinic visits.
• Coordinates appeals with clinicians and patient families by preparing letters of appeal or connecting the clinician directly with the insurance company.
• Answers, screens and routes a high volume of phone and email inquiries from patients and families and external companies in coordination of services. Records and forwards messages and triages calls to nurses, physicians and numerous other providers for urgent information or services. Initiates calls for emergency services as required.
• Responds to patient’s concerns and needs within scope of knowledge and authority and in accordance with our best practices and procedures. Responds to situations requiring escalated service response, ensuring the appropriate providers and parties across multiple specialty areas are made aware of concerns and follows up to ensure resolution.
• Schedules patient encounters and procedures to coordinate within and across providers in multiple specialties. Obtains and records required authorizations on electronic or manual scheduling systems to compile and distribute patient and staff schedules. Verifies patient demographics, insurance/payment and referral information for patient encounters. Collects all necessary clinical documentation and information.
• Collects and organizes medical records, information, materials and supplies required for admissions or encounters. Prepares requisitions and other standard forms as requested by clinician or supervisor. Communicates with other departments to coordinate ancillary clinical/administrative services. 
• Participates in the development of training programs to update staff on department/hospital processes particularly as it relates to prior authorization for treatments, drugs and medical procedures.
• Trains, orients and cross-trains clinic staff in department systems, processes and terminology.
• Demonstrates high-level problem resolution skills. Provides assistance to other support staff in evaluating and resolving problems and issues.
• Serves as a resource on clinic/service/unit operations and procedures, payer and billing requirements and related matters.
• Actively participates in and contributes to departmental and organizational initiatives and projects with a focus on continuous process improvement.
• Recommends and assists in implementing change in internal systems and procedures

To qualify, you must have:

• High school diploma- required
• Some college or occupationally specific education/training.
• 2 years of experience in a high volume administrative role with an emphasis on problem resolution among multiple internal and/or external parties. At least 1 of the 2 years should be in a healthcare or health insurance setting working with the prior authorization process.