Enhanced Benefits Coordinator Augusta

WellStar Health System; United States; On-site; USD 45,000 - 55,000; Full time

Job summary

Wellstar Health System is seeking an Enhanced Benefits Coordinator to serve as the hub for prior authorizations across our medical center and clinics. You will verify insurance and financial information, obtain precertifications, and provide benefits overviews to patients before treatment, acting as the front-line contact for patients, families, providers, nurses, social workers and pharmacies.

The role emphasizes accuracy in processing authorizations, coordinating with Pharmacy and Medication

Qualifications

• High School Diploma or GED required; Bachelor's degree preferred.
• Pharmacy Technician certification (PHT) preferred or required upon hire.
• Experience with benefits, claims adjudication and prior authorizations.

Responsibilities

• Screens and processes prior authorization through medical and pharmacy benefits.
• Follow-ups with patients, providers and payers for refills and reauthorizations.
• Process infusion/injection appointments using IT platforms.
• Coordinate with Medication Assistance Coordinators for specialty meds.
• Coordinate shipping of patients’ medications to ensure timely delivery.
• Collaborate with Pharmacy Department for quality assurance and customer service.

Skills

Communication

Organization

Prioritization

Time management

MS Office

Medical terminology

Prior authorizations

Education

High School Diploma / GED

Bachelor's degree preferred

Job description

How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives.

Work Shift Various (United States of America)

Job Summary

The Enhanced Benefits Coordinator serves as the hub for prior authorizations associated with key service lines within the medical center as well as health system clinics. This position will obtain and validate insurance and financial information, obtain any required precertification and/or prior authorization for in office administered medications, and provide benefits overviews to patient prior to treatment. This position is responsible for providing front line, direct contact with patients, families, providers, nurses, social workers and pharmacies.

Core Responsibilities and Essential Functions

• Screens, processes, and completes prior authorization through medical benefits and pharmacy benefits.
• Follows-up with patients, providers, and insurance plans on refills and reauthorizations, as required by payers.
• Processes infusion/injection appointments through WMCG IT platforms in an accurate manner.
• Coordinates with Medication Assistance Coordinators for specialty medications filled through pharmacy benefits or medications accessed through assistance programs.
• Coordinates shipping activities associated with patients own medication to ensure accurate and timely medication delivery.
• Collaborates with other members of the Pharmacy Department team for performance improvement, customer service excellence, and quality assurance (teamwork).
• Performs other duties as assigned.
• Complies with all Wellstar Health System policies, standards of work, and code of conduct.

Required Minimum Education

• High School Diploma / GED General or Bachelors General-Preferred

Required Minimum License(s) and Certification(s)

• All certifications are required upon hire unless otherwise stated.
• PHT - Registered Pharmacy Tech

Required Minimum Experience

• Minimum 1 year Pharmacy Technician role or in enhanced benefits or similar role in medical office/center, Pharmacy required
• Minimum 2 years Pharmacy Technician role or in enhanced benefits or similar role in medical office/center, Pharmacy preferred

Required Minimum Skills

• communication skills, organizational skills, prioritization, time management.
• Microsoft Office proficiency
• Proficient with medical terminology
• Experience with prior authorizations, insurance, claim adjudication and claim appeals.

Join us and discover the support to do more meaningful work—and enjoy a more rewarding life. Connect with the most integrated health system in Georgia, and start a future that gives you more. Nationally ranked and locally recognized for our high-quality care and inclusive culture, Wellstar is one of Georgia’s largest and most integrated healthcare systems. Every day, 24,000+ of us work together to provide personalized care for patients at every age and stage of life – and our team members are the foundation of that care.

Mission, Vision & Values

At a time when the healthcare industry is changing rapidly, Wellstar remains committed to exceeding patients’ and team members’ expectations, while transforming healthcare delivery. OUR MISSION: To enhance the health and well-being of every person we serve. OUR VISION: Deliver world-class healthcare to every person, every time. OUR VALUES: We serve with compassion We pursue excellence We honor every voice Culture of Excellence Wellstar consistently receives attention and accolades from national organizations that set the standards for world-class care. Our system-wide practice of safety principles, assessing and addressing errors and seeking feedback from our patients and customers continually earns recognition for advances in safety and quality. Featured on the FORTUNE “100 Best Companies to Work For” list and Seramount 100 Best Companies list, we not only provide top-notch care for our patients, but also foster the culture of Wellstar as a Great Place to Work.