Prior Authorization and Medical Records Coordinator- Outpatient Behavioral Health

Prior Authorization and Medical Records

Tri Health Outpatient Behavioral Health***

The Prior Authorization and Medical Records Specialist is responsible for obtaining and managing insurance authorizations to support timely patient access to services within various Behavioral Health programs, including partial hospitalization (PHP), intensive outpatient program for addiction (IOP), neuropsychology, and psychiatric medication management practices. This role serves as a liaison between providers, patients, and insurance payers to ensure required authorizations are secured prior to treatment, testing, and medication services.

The specialist reviews clinical documentation, submits authorization requests, tracks approval statuses, manages denials and appeals, and maintains accurate records within the electronic medical record. Success in this role requires strong organizational skills, attention to detail, knowledge of insurance requirements, and a commitment to supporting high-quality patient care through efficient and compliant authorization processes.

We offer career growth opportunities , a comprehensive benefits package, and competitive pay based on level of education and experience.

• North – Tri Health Evendale Medical Office Building, 3147 Glendale Milford Rd, Cinti 45241
• West – Tri Health Physician Partners, 6331 Glenway Avenue, Cinti 45211

• Full-Time (80 hours bi-weekly)
• No Holidays!

In addition to a comprehensive benefits package—including medical, dental, vision, paid time off, retirement plans, and tuition reimbursement—this role offers competitive pay based on education level and experience. Please view our benefits page

• Graduate of an approved technical, professional, or vocational program in Healthcare;
  Healthcare clinical experience preferred physician practice or related field
• Equivalent experience accepted in lieu of degree
• Must be certified or registered medical assistant
• Must maintain this certification and registration status Registered Medical Assistant (RMA), through AMT, NCCT, or NHA, or certified Medical Assistant (CAN) by AAMA, and Cardiopulmonary Resuscitation (CPR)
• Medical office flow, especially the clerical/front office tasks
• Ability to make quick decisions based on well thought out consequences/results
• Knowledge of EMR, practice management software and medical coding/billing strongly encouraged

This position provides both direct patient care in a primary care office and works with care delivery providers to identify gaps in care, contacts patients to schedule required care, and provides referral follow up. The Medical Home Medical Assistant provides pre-visit planning for the practice's patient panel, coordinates messages through electronic portals, and assists in managing transitions of care. The Medical Home Medical Assistant will act as a clinical liaison to the physician care plan and actively communicate with patients.

The MA participates in process improvements, is knowledgeable of clinical goals and outcomes including patient satisfaction and engagement. Other job-related duties may be assigned to meet the needs of the department. Must be certified or registered medical assistant and have strong skills in clinical care, customer service, communication, and teamwork. This role understands the needs of the organization and supports the mission, values, and management of Tri Health Physician Practices.

• Demonstrates proficiency in the rooming process for adult and/or pediatric primary care including: clinical procedures, immunizations, venipuncture, point of care testing, among others. Follows protocols and policies for scheduling, clinical procedures and appropriate use of medical equipment. Provides accurate/complete documentation of clinical calls and patient rooming info as well as order entry, pending prescriptions, noting current pharmacy, and enter edit workflows to result orders.
  
  Addresses patient messages (phone, mychart) in a timely manner and escalates patient issues as appropriate. Demonstrates clinical competency upon completion of orientation and annually.
• Main…