Description
Athena Care is a growing insurance-based practice focused on meeting the needs of our community while maintaining strong patient-focused values we've held for over 20 years. We offer psychological testing, IOP/PHP, Spravato/IM Ketamine, TMS, psychotherapy, group therapy, and general psychiatry under one roof. Our goal is to create a small group practice feel on the ground with strong business expertise and technology behind the scenes, enabling our team to focus on patient care and our patients to access care with ease.
TMS, Spravato and ketamine are treatments for patients with severe depression who have not been helped by other treatments. The Interventional Psychiatry Authorizations Coordinator works with the rest of the Interventional Psychiatry intake team to coordinate the insurance and administrative process for new patients to enter treatment for TMS and/or Spravato, including working with providers to screen patients for appropriateness, determining when additional information from the patient is required and obtaining authorization from the patient’s insurance as required.
Core Job Duties/Responsibilities
- Verifies eligibility, authorization, and patient responsibility for interventional psychiatry services
- Submits, tracks, and follows up on prior authorization requests including determining the appropriate method and forms for submission; submitting via fax, phone or electronically as appropriate; calling to check on status and track requests that have been pending; handling appeals; and scheduling peer-to-peer reviews
- Tracks and timely submits reauthorizations as needed and coordinates with the treatment team to resolve issues or alter authorizations as needed
- Reviews patient information following initial consultation to determine whether any questions regarding patient suitability need to be referred for review to providers
- Reviews record to determine any additional information needed and communicates with patients to obtain such information
- Coordinates with outside providers to obtain medical clearance where required
- Coordinates with the intake team to ensure patients receive accurate information about costs before and during treatment
- Identifies and enrolls Spravato patients with the appropriate pharmacy
- Works closely with the entire interventional psychiatry team to ensure patients are timely entering treatment, including tracking progress through the process and following up with other team members to ensure all parts of the process are proceeding smoothly and without delay
- Identifies patient needs, clarifies information, researches every issue and provides solutions
- Provides superior customer service to all individuals
- Performs other duties as assigned
Requirements
- Education/Experience:
- High school diploma or equivalent required; associate’s or bachelor’s degree preferred
- Experience with insurance authorization process
- Experience reviewing and understanding medical records
- Knowledge, Skills, & Abilities:
- Knowledge of insurance eligibility and authorizations processes and procedures
- Ability to work with a multifunctional team to ensure the best patient experience
- Ability to track and prioritize multiple tasks and requests
- Strong attention to detail
- Strong communication skills, with the ability to interact professionally with internal teams and outside providers, insurers, pharmacies, and patients
- Good customer service in patient-facing and provider-facing interactions
Athena Care Core Values
A – Accountable to our patients and other Athenians
T – Team – every Athenian plays an important role
H – Helpful to our teammates, patients, and our communities
E – Empathetic in our service to our patients and each other
N – Nurture our patients, referral relationships, and other Athenians
I – Integrity in our interactions with patients and other Athenians
A – Analytical in evaluating our performance
N – Nimble in support of our mission to expand access to quality mental health
