Planned Parenthood North Central States

Centralized Services Lead – St. Paul, MN

Starting salary for candidate who meets minimum requirements (Experience will be compensated): $22 - $26/hour

Typical Schedule: 40 hours/week

About Us:

At Planned Parenthood North Central States (PPNCS), we believe all people deserve the right, the freedom, and the opportunity to follow their personal ambitions and choose their own path toward a healthier, more meaningful life. That’s why we protect, promote, and provide comprehensive and progressive sexual and reproductive health care for generations of young people and families with empathy, care, and respect. We are looking for passionate, dedicated staff who are eager to make positive contributions to their community and to the Planned Parenthood mission.

Click here to learn more: Our Mission

Under the direct supervision of the Director of Telehealth and Centralized Patient Care, and general supervision of the Medication Program Manager and Centralized Services Manager, the Centralized Services Lead supports Centralized Services and the Medication Program by monitoring day to day operations and serving as a frontline contact for the Centralized Services Associates. The Lead provides real time support and coaching of staff, maintains up to date information in the Knowledge Base System, and monitors Associate productivity and team metrics in real time. The Centralized Services Lead provides rotating onsite evening and weekend coverage to ensure proper support and resources are available to staff. The Centralized Services Lead assists with the maintenance of efficiencies in Centralized Services processes and identifies opportunities to increase effectiveness and promote excellent patient and staff experience. The Centralized Services Lead handles escalated patient contact and navigates the appeals process for Prior Authorizations. The Lead is an advocate in implementing our mission “To affirm the right to reproductive and sexual health and freedom for all by providing excellent care, trusted education, and fierce advocacy”. They may perform other related duties as assigned.

Schedule: Monday - Friday, primarily from 8am to 6pm. May include some evening and weekend shifts.

Responsibilities:

This position will impact us with the following contributions:

Expert in all centralized services associate functions and responsibilities -

• Pre-Procedural Phone Calls; Medical Records; Patient Charts; Prior Authorizations; Lab Results; Medications/Refill Program
• Facilitates training and onboarding for new Centralized Services staff
• Serves as the first point of contact for the Associate team for general questions, and day to day operations

Leadership of centralized services associates -

• Proactively identifies coaching and training opportunities through real time observations of staff
• Follows up with Associates as appropriate to discuss errors and provide coaching in real time
• Escalates situations, questions, and performance concerns to Managers as appropriate
• Handles escalated and complex calls
• Provides coaching and support to staff handling suspicious calls
• Monitors Centralized Services metrics and implements adjustments or escalates to Management as appropriate
• Ensures compliance with Centralized Services Associate daily staffing assignments
• Monitors staff productivity logs in real time and follows up, implements adjustments, or escalates to Management as appropriate
• Performs bi-monthly and quarterly quality control audits regarding medical records related tasks
• Maintains and updates Centralized Services Knowledge Base System along with content of supplemental resources
• Provides rotating evening and weekend coverage

Prior authorization specialist -

• Facilitates the appeals process for Prior Authorizations
• Serves as primary contact to notify and update patients about Prior Authorization requests that have been denied
• Investigates denials, collates necessary information from providers, and files appeals on patients’ behalf
• Maintains working knowledge of Prior Authorization requirements for common payers and diagnoses
• Communicates effectively with relevant subject matter experts, including the Gender Affirming Hormone Therapy leadership team, Centralized Follow Up clinician team, and LGBTQ Care Coordinators to ensure rapid response to all Prior Authorization requests and denials
• Provides escalated support for Centralized Services Associates and patients to respond to unusual, urgent, or non-routine prior authorization requests from insurance companies and pharmacy benefit managers
• Reviews complex prior authorization requests with clinicians, physicians, and SMEs as appropriate and completes the submission process
• Masters multiple cloud-based portals and computer programs for processing prior authorization requests and appealing denials
• Ensures that prior authorization appeal process is initiated immediately upon receipt of a denial, coordinating efforts with Centralized Services Associates to ensure a timely response to all denials, including compassionate and informative communication with the patient about the process
• Ensures accurate and up-to-date completion of internal Prior Authorization tracking sheet by Centralized Services Associates

Minimum Qualifications:

• 2+ years customer service experience
• Must meet one of the following criteria:
• 6 months experience as a Centralized Services Associate, Virtual Care Associate, Patient Services Associate, or Health Center Associate; OR
• 6 months experience in a supervisory or leadership role in a health care setting; OR
• 6 months experience processing appeals for prior authorizations
• Extensive knowledge of healthcare services and practices

Benefits:

This position is eligible for:

• A comprehensive benefits package, including:
  • Medical, Dental, Vision – With equity-based premium tiers
    • NICE HEALTHCARE – free, virtual primary care for entire household (in-home available for qualifying locations) Services include: 80 free labs, free x-rays, and physical tests, live, virtual physical therapy, 550+ free medications
  • Flex Spending Account
  • Life insurance
  • Eligibility for Federal Student Loan Forgiveness
  • PTO, Float holidays, Volunteer Paid Time Off, Paid Holidays
  • 403(b)
  • Eight weeks paid Parental Leave
  • One Week Paid COVID leave, if necessary
  • Pet Insurance

Please note:

We require all PPNCS employees, volunteers, interns, and fellows to have a current, up-to date, COVID vaccine (Exemptions may be provided for medical, disability (ADA) or religious reasons.)

Planned Parenthood North Central States supports people of all ages in making responsible choices and planning their futures. We are an organization committed to creating and fostering an environment that leads to engaged employees, and we believe engaged employees results in satisfied customers and exceptional experiences. When you work for Planned Parenthood you make a difference in the lives of those we serve by affirming the human right to reproductive health and freedom.

Planned Parenthood is an affirmative action and equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, sex, gender identity or gender expression, national origin, age, veteran status, marital status, religion, sexual orientation, size, disability, socioeconomic status, or status regarding public assistance. Planned Parenthood is committed to encouraging and promoting diversity as well as providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities. Planned Parenthood is dedicated to an equitable and inclusive work environment and encourages all interested candidates to apply regardless of initial skill set.

Any job offer will be contingent upon the results of a background investigation.

Questions? Contact Jobs@ppncs.org for more information.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)