Medical Assistant - Central Nurse Triage

Overview:

Location: Downers Grove; In-Office

Hours: Monday-Friday, 8:30-5:00pm
• Duly Health and Care works to understand what matters most to you. We recruit and retain team members who share a relentless passion and pride for helping others live happier and healthier lives. We invest in helping our team members develop their talents in a way that is rich in personal meaning. We invite you to join us, fulfill your purpose and make your mark!

Benefits:

Comprehensive medical, dental, and vision benefits that include healthcare navigation assistance and medical coverage at 100% (after deductible) when utilizing a Duly provider.

Employer provided life and disability insurance.

$5,250 Tuition Reimbursement per year.

Immediate 401(k) match.

40 hours paid volunteer time off.

A culture committed to Diversity, Equity, and Inclusion (DEI) and Social Impact.

12 weeks parental leave at 100% pay and a financial benefit for adoption and surrogacy for non-physician team members.

Responsibilities:

Performs all Telecare Medical Assistant duties ( 20%)Telecare Medical Assistant duties including but not limited to prioritizing phone calls, processing/pending refills, relaying test results, providing patient education and outreach under the direction of the physician champion and nurse management directives.

In-basket tasks including but not limited to faxing requests under HIPAA guidelines, generating patient outreach letters, updating patient EMR records, transcribing faxed prescriptions into EMR system and routing to the appropriate party for processing.

Acts as a resource to peers and supervisor (10%)Occasionally assists Lead Telecare Medical Assistant with training new staff.

Participates with time studies when new workflow developments are created for new Telecare Medical Assistant tasks.

Participates in Telecare Medical Assistant/Clerk related projects as needed.

Acts as resources to clerk (5%)In the absence of the support clerk, comes into the office as needed to complete clerk duties.

All other duties as assigned per Management discretion.

Prior-Authorization:

Data Collection and Documentation (25%)Receives and documents, telephonic, and/or electronic requests for medications that require prior authorizations - source of request is from Primary Care Physicians, Specialists and Ancillary providers.

Verifies member eligibility and basic benefit coverage levels including obtaining information on coordination of benefits and third-party liability as appropriate

Utilizes computer resources and available resources both internal and external, to determine provider networks.

Evaluates each Prior Authorization request to ensure the request including codes, place of service, service type, provider, and all required medical information is available for submission to insurance carrier or approving entity.

Investigates and obtains from providers, missing medical information required for Prior Authorization submission.

Maintains accurate and appropriate documentation and follows patient privacy in accordance with HIPPA and DMG policies and procedures.

Interface with Health Plans and Provider offices (20%)Contacts physician offices, pharmacies, review organizations and insurance companies to obtain prior approval requirements, and submit appropriate forms and clinical documentation.

Works with physician offices to provide ongoing education regarding prior authorization process and requirements.

Maintains a current working knowledge of all health plan carrier requirements as it relates to requests for prior authorizations and approval path requirements (pre-determinations and peer to peers)

Applies clinical knowledge and application of health plan formularies, ICD-9 and CPT coding, as well as medical terminology for appropriate communication with physicians and providers.

Functions as a resource to physician/provider offices regarding prior authorization requirements, networks, and alternate medication availability as recommended by the patients' health plan.

Provides source of prior approval request with timely notification of approval or denial decisions through designated communication routes

System enter and other functions (20%)Performs data entry/processing of prior authorization requests through the EPIC system, and edits Prior authorization notes with appropriate information as outlined per department guidelines and procedures.

Maintains accurate and detailed prior authorization notes and patient chart documentation entries.

Resources Team Lead or Supervisor/Manager for review of complex requests and issues

Provides input to Team Lead and Supervisor/Manager regarding improvements to operating practices.

Assists with orientation and training of new staff.

Qualifications:

LICENSE/CERTIFICATION:

CPR certification required.

Active Medical Assistant certification through one of the following: American Association of Medical Assistances (AAMA), American Medical Technologists (AMT), National Center for Competency Testing (NCCT), National Healthcare Association (NHA) preferred.

EDUCATION:

High School diploma or GED and a graduate of an accredited Medical Assistant program preferred.

EXPERIENCE:

Preferred 1-2 years of experience in as a medical assistant in a medical office setting such as a physician office, hospital, or long-term nursing facility and or healthcare call center.

The compensation for this role includes a base pay range of $19-$22, with the actual pay determined by factors such as skills, experience, education, certifications, geographic location, and internal equity. Additional compensation may be available through shift differentials, bonuses, and other incentives. Base pay is only a portion of the total rewards package.