Plan Determination Coordinator
Univita Health - Woodbury, MN

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It's the new age of independence. And it's changing the way we live.
BE PART OF IT. UNIVITA is dedicated to helping people live and age with independence. By providing a single place to find and manage resources which support independent living, UNIVITA makes it easier to access care and to age safely at home.

This is your opportunity to join an innovative company with a culture that promotes compassion, trust, and accountability.

ABOUT THIS OPPORTUNITY In this role, you will be responsible to ensure that all FFS (Fee for Service) authorization requests are sent to the health plan and followed up appropriately. They are to submit to the health plans the Medical Reviews processed for determination. RESPONSIBILITIES
  • Obtains as much information as possible in order to expedite the order. Verifies patient order information, determines charges/coverage for service requested, collects co-payments/deductibles and inserts data into Patient Manger DME/Med Trac.
  • Verifies eligibility/benefits; attaches eligibility/benefits to delivery ticket in Patient Manger DME/Med Trac for quality assurance verification purposes and for patient’s medical record.
  • Communicates with the health plans, patients, and/or physicians regarding status of pending authorizations orders in accordance with the 7 business day protocol for authorizations/quotes.
  • Ensures that the Intake/Referral Coordinator has obtained prescriptions, clinicals, and/or physician orders in order to generate a quote form for authorizations requests or the Medical Review Form.
  • Completes the Medical Review Form in order to submit to plan for determination.
  • Processes orders for quotes verifying the contract guidelines for the health plan.
  • Follow up on authorization requests on a daily basis and/or based on the health plan requests.
  • Understand and complies with policy only permitting Clinical Reviewers to apply clinical guidelines and interpret clinical data on referrals for service.
  • Addresses complaints concerning “pending” authorizations/medical reviews, referring complaints to the Plan Determination Supervisor.
  • Ensures that complaints are logged in the Consumer Log located in the N drive.
  • Performs other duties as assigned.
Minimum Qualifications
  • High School Diploma or general education degree (GED).
  • Minimum two years’ experience in Customer Service activities within the Health Care Industry field.
  • Able to maintain confidentiality of patient information per company policy and HIPAA requirements.
  • Required to uphold the principles of compliance as outlined in the Code of Conduct, Employee Handbook and related policies and procedures. Supports and participates in the mandatory Corporate Compliance Program training initiative on an annual or more frequent basis, as required.
Preferred Qualifications
  • Bilingual (English and Spanish additional languages a plus)
  • Medical Background Knowledge
  • Demonstrates autonomy, organization, assertiveness, flexibility, and cooperation in performing job responsibilities.
Univita offers a competitive and complete benefits package.

Univita Health - 18 months ago - save job - block
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