Sr Patient Administrative Coordinator

Boston Children's Hospital; Boston (MA); On-site; USD 55,000 - 70,000; Full time

Benefits offered by this job

Flexible schedules

Health insurance

Vision insurance

Dental insurance

Time off & retirement plan

Job summary

Boston Children's Hospital seeks a detail-oriented coordinator to manage the prior authorization process for treatments across multiple specialties. The role coordinates with insurers, pharmacies, and families, ensuring timely access to care during clinic visits.

It also trains staff on related processes and improves internal workflows. Responsibilities include handling patient encounters, scheduling, and recording necessary authorizations, while maintaining high standards of communication and

Qualifications

• 2 years of experience in healthcare or health insurance with prior authorization.
• Experience handling high-volume phone and email inquiries.

Responsibilities

• Manages authorization for a variety of medicines and procedures across providers.
• Coordinates with insurance companies and families for delivery of treatments during visits.
• Prepares letters of medical necessity based on physician notes.
• Trains clinic staff on department processes and payer requirements.
• Acts as subject matter expert on prior authorization processes.

Skills

Phone support

Email correspondence

Training & onboarding

Process improvement

Education

High School Diploma or GED

Tools

Scheduling systems

Job description

Position Summary:

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. Coordinates communications and services with insurance companies, medical device and supply companies, and specialty pharmacy companies in support of providers' care. Provides training and guidance to center/program staff on related administrative processes and procedures.

Key Responsibilities: Authorizations

• Manages the authorization process for a significant variety of medicines, specialized treatments, medical procedures, etc. for patients across multiple providers and specialties. Prepares 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.
• Serves as point of contact and subject matter expert on the process for obtaining and responding to additional requests for prior authorizations across relevant insurance companies for supported clinical area. Coordinates as necessary with pharmaceutical companies to improve processes for obtaining authorizations for the most complex drugs.

Patient Encounters

• 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.
• 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 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.

Training

• 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.

Process Improvement

• 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

Minimum Qualifications: Education:

• High School Diploma or GED

Experience:

• 2 years of experience including healthcare or health insurance setting working with prior authorization.

The posted pay range is Boston Children's reasonable and good-faith expectation for this pay at the time of posting.

Base pay is one part of a comprehensive benefits package that includes flexible schedules, affordable health, vision and dental insurance, child care and student loan subsidies, generous levels of time off, 403(b) Retirement Savings plan, Pension, Tuition and certain License and Certification Reimbursement, cell phone plan discounts and discounted rates on T-passes. Experience the benefits of passion and teamwork.

• flexible schedules
• affordable health
• vision and dental insurance
• child care and student loan subsidies
• generous levels of time off
• 403(b) Retirement Savings plan
• Pension
• Tuition and certain License and Certification Reimbursement
• cell phone plan discounts
• discounted rates on T-passes