Prior Authorization Specialist

Texas Health Action (THA) is a community-informed non-profit organization dedicated to providing access to culturally affirming, quality health services in a safe and supportive environment, with expertise in serving LGBTQIA+ people and those impacted by HIV. Kind Clinic proudly serves Texas with four vibrant locations: two in Austin, one in San Antonio, and another in Dallas plus virtual care services available to all residents across Texas. Bolstered by Waterloo Counseling Center and a passionate team of over 250 dedicated employees and volunteers, THA is at the forefront of promoting healthcare equity and accessibility throughout the state. Read more about THA here: http://texashealthaction.org.

The Prior Authorization Specialist serves our Kind Clinics and Waterloo Counseling Center’s operations by aiding with all administrative functions of our KIND clinics; in a manner that supports the delivery of quality patient care. This role is primarily responsible for ensuring that all our prior authorizations are submitted accurately and timely, to ensure we provide patients with access to their medications. This is a full-time, non-exempt position requiring 40 hours a week.

Core Functions:

• As a Prior Authorizations Specialist, you will be responsible for managing the prior authorization process for medications
• Collaborate with healthcare providers, insurance companies, patient advocates and patients to obtain necessary approvals and ensure compliance with insurance requirements
• Communicate with healthcare providers to gather necessary documentation and information
• Review and submit prior authorization requests to insurance companies and follow up on the status
• Maintain accurate records of all prior authorization activities
• Provide excellent customer service to patients and healthcare providers
• Stay updated on insurance policies and guidelines to ensure compliance
• Assist in the facilitation of prescription refills, laboratory orders and results, and prior authorizations while effectively prioritizing workload to ensure all are managed in a timely manner for optimal patient care.
• Input and update information into applicable electronic health records
• Monitor issues affecting client access, adherence, and/or retention in care, and notifies key staff of barriers to care so clinic and advocate staff can proactively advocate
• Acts as a liaison between laboratory, clinicians, advocacy team, and patients 
• Interprets program guidelines, and other policies and procedures for operations
• Complete other clerical duties and office tasks as assigned 
• Maintain a system of confidentiality according to clinic’s policies and procedures and in alignment with HIPAA guidelines
• Continuously meet or exceed organization defined metrics regarding call/patient interactions 
• Resolve patient complaints and escalate to additional leadership support as needed, and within appropriate timeframe
• Assist other members of the Patient Access Team and Waterloo Counseling Center, as needed
• Perform other duties as assigned

Compensation

Based on job duties and requirements, this position is placed in salary band 38 with an hourly rate of $20.80 per hour. Initial placement will be based on hired candidate's qualifications and relevant experience.

Applicant Information:

• Submitting official transcripts, diplomas, certifications and licenses may be required prior to final offer. Unofficial transcripts and copies of other relevant documents may be attached to the application for consideration in advance.
• Information regarding employment history as it relates to the qualifications of the position may be needed for employment verification.
• The applicant selected for employment is subject to a pre-employment background check. A history of conviction may not automatically disqualify an applicant. Applicants with a history of conviction may be considered on a case-by-case basis, after individualized assessment of factors including the nature of the conviction, the job duties and responsibilities, the length of time since the conviction, and evidence of mitigation or rehabilitation. If required for the position, a physical, motor vehicle record evaluation, and additional background checks may be conducted.

EEO Statement: Texas Health Action is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.

Education and/or Licensure – H.S. Diploma or equivalent experience required. No licensure required.

Experience – 1+ years experience in a medical setting processing prior authorization. Knowledge of medical terminology, procedures and diagnosis. Knowledge of general administrative and clerical procedures. Microsoft Office Skills with an ability to become familiar with company or position specific programs or software.

Additional Preferred Requirements – Bi-lingual (English/Spanish) a plus. Experience in clinical setting serving in a Medical Assistant capacity. Experience in HIV testing, HIV services, STI testing, and treatment clinic.  2+ years of experience in working with diverse populations, including LGBTQIA+ and other marginalized populations.

• Health Care Plan (Medical, Dental & Vision)
• Retirement Plan (403b)
• Life Insurance (Basic, Voluntary & AD&D)
• Paid Time Off (Vacation, Sick & Holidays)
• Short Term & Long Term Disability
• Training & Development
• Parental Leave
• Longevity pay