DMEPrior Authorization Partner - Boston MA
DMEPrior Authorization Partner - Boston MA
Posted on :
16-03-2025
Employer Active
1 Vacancy
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Job Description
Who is Gather Health
Gather Health is a collective of outreach partners care partners clinicians and most importantly patient partners who work together to reshape lives and communities. We bring handson social and medical care to our patients and work around their needs both within our care facilities and in their homes. We work alongside local leaders to build communities and provide tailored care experiences that serve the seniors that live within them. When we Gather we show love compassion community and care.
What is this role about
We are seeking a Prior Authorization Partner who has pharmacy and durable medical equipment responsibilities to support Gather Health an atrisk primary care group for seniors.
What are some of the daytoday duties This clinicbased role will include responsibilities for pharmacy prior authorizations and DME coordination. Some of the daytoday duties will include but are not limited to:
- Pharmacy Prior Authorization Responsibilities:
- Manage the submission follow up and completion of pharmacy prior authorization requests
- Collaboration with PCPs to determine if an alternative medication may be acceptable based on insurance coverage preferences
- Verify that approved prior authorizations result in successful claim processing at the pharmacy
- Maintain detailed progress notes in the Electronic Medical Record
- Provide regular updates to patients and external partners (e.g. pharmacies insurance companies) regarding the status of prior authorizations
- Communicate with the pharmacy to confirm successful claim adjudication
- Additional duties as assigned
- Durable Medical Equipment (DME) Coordination Responsibilities
- Accept and process DME requests submitted by Primary Care Physicians (PCPs) and external partners (e.g. therapists home health agencies).
- Follow up with DME suppliers to confirm that all necessary medical criteria documentation is provided. Ensure the documentation meets insurance and regulatory requirements.
- Communicate with patients to provide status updates and confirm that ordered DME products are received.
- Additional duties as assigned
What are the minimum requirements for this position
- At least one year of experience in processing prior authorizations insurance referral coordination and/or DME coordination
- Familiarity with Medicare and Medicaid programs as well as valuebased care models a plus
- Experience with basic office tools such as email Outlook calendar etc.
- Strong verbal written and reading comprehension skills in English
- Ability to work regular office hours Monday through Friday
- Ability to work for any employer in the United States
What are the nice to have preferred requirements
- Effective communication and interpersonal skills
- Selfmotivated and capable of working independently with moderate supervision
- Willingness to work with complex populations to resolve medical issues quickly
- Strong prioritization flexibility and adaptability skills
- Bilingual in Haitian Creole and/or Spanish
What are the traits of someone most likely to succeed in this role
- Organized manages time effectively and operates efficiently
- Motivated thrives in a busy environment
- Friendly people enjoy their company because of their joyful nature
- Compassionate they treat people with kindness
- Patient they are not easily frustrated or flustered
- Resourceful they are creative when it comes to problem solving
- Positive sees glass as is half full vs. half empty
- Reliable takes responsibilities seriously and always shows up on time
What are the hours for this position
- Monday Friday 8:00am 5:00pm
Why should I join Gather Health
- We are a missionbased organization that is passionate about changing the way seniors experience primary care
- Our business model is unique and on the cuttingedge of the primary care industry
- Our leadership team is comprised of experienced individuals who are committed to creating not only the best patient experience but also an amazing employee experience for our colleagues
- We are intentionally building a strong company culture and providing a compassionate and joyful work environment
- The organization was conceptualized founded and launched by experienced cofounders with a track record of success in the healthcare space
- We offer competitive pay and benefits for our FullTime colleagues including:
oPaid Time Off (total of 3 weeks per year PTO that accrues with each pay period)
o11 Paid Holidays
oMedical insurance coverage (health dental vision) with no waiting period for enrollment
oShort and LongTerm disability insurance at no cost to you
oBasic life insurance coverage at no cost to you
o401K plan with 100 employer match up to 4 of income
oEmployee Assistance Program at no cost to you
oFree onsite parking
oSupplemental benefits available for discounted prices (legal services Aflac hospital indemnity
accidental death & dismemberment etc.
Gather Health is an Equal Opportunity Employer. All employment decisions are made without regard to age race creed color religion sex national origin ancestry disability status veteran status sexual orientation gender identity or expression genetic information marital status citizenship status or any other basis as protected by federal state or local law.
Employment Type
Full Time
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