Description
Job Summary:
The Prescription Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations from insurance carriers by receiving prescriptions, addressing and rectifying rejected claims and conducting necessary third party authorization requests.
The Prescription Prior Authorization Specialist has direct over-the-phone interaction with patients and is an integral component in helping deliver our mission of bringing state-of-the-art expertise and patient care to our clientele.
Why Waccamaw Dermatology:
If you are looking to be a part of a dynamic team who enjoys helping others and believes that quality healthcare is for everyone, bring your critical thinking skills, positive attitude, cheerful smile and join a special team that makes a true difference!
Duties/Responsibilities:
- Assists with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed.
- Follows prior authorization workflow and policies and procedures.
- Collaborates with other departments to assist in obtaining prior authorizations.
- Reviews accuracy and completeness of information requested and ensure that all supporting documents are present.
- Receives requests for prior authorizations and ensure that they are properly and closely monitored.
- Consults with supervisor or pharmacist to obtain clearance that treatment regimen is appropriate.
- Processes referrals and submit clinical supporting documentation to insurance carriers to expedite prior authorization processes.
- Manages correspondence with insurance companies, physicians and patients as required.
- Reveiws denials and submit appeals if requested by physician to get them approved from insurance companies.
- Documents all prior authorization information including approval dates, prior authorization number in patient profile.
- Proactively works on prior authorizations that are due to be expired.
- Secures patients’ demographics and medical information by using great discretion and ensuring that all procedures are in sync with HIPAA compliance and regulations.
- Maintains patient confidence and protects operations by always keeping information confidential in compliance with all HIPAA and OSHA rules and regulations.
- Contributes to team effort by accomplishing all related tasks as needed.
- Always provides superior customer service excellence.
- Remains flexible on behalf of the position and the team.
- Ability to interact both positively and professionally through multiple departments within the practice.
- Ability to work both independently as well as within a team environment.
- All other duties as assigned.
Requirements
Education and Experience Requirements:
- Medical Assistant experience or the equivalent medical background in a high-volume medical setting with the ability to read, write and interpret medical terminology, dermatology a plus.
- Ability to speak other languages a plus.
Working Conditions
- Required to move from one location to another within and outside of the building; push, pull and reach; bend; sit for extended periods of time
- Ability to work 8-10+ hour shifts and be available for overtime when necessary.
- Must be able to speak and write English fluently.
- Ability to lift to 25 lbs.
On-Site Presence Required at least three days per week with the option to potentially work remotely two days per week following a successful in-person training plan.
Hours: TBD based upon department needs between the hours of 7:00am-5:30pm Monday - Friday as assigned.
