Prior Authorization and Benefits Specialist Hybrid

Job Title:

Prior Authorization Specialist Hybrid Duties:

Communicates with payors via phone/fax/ePA to obtain Prior Authorization for prescribed medications and/or services. Reviews EMR and PA Software to identify medications requiring Prior Authorization. Responds to outstanding prior authorization requests. Maintains records of medical policies and responds to staff questions regarding payor medical policies. Supports patients taking high risk and biologic medications and coordinates renewals and routine screenings. Maintains accurate and timely record-keeping of all electronic medical records and actions taken. Maintains prior authorization tracking spreadsheet including data entry and reporting. Ensures timely processing and communicates authorization status with physicians and their teams Predicts payor decisions and advises physicians when additional supporting documentation is recommended or required. Appeals authorization denials as directed by physicians. Anticipates and processes renewals for expiring authorizations. Screens and processes refill requests as appropriate. Maintains knowledge of manufacturer assistance programs and communicates with drug vendors and sales representatives as appropriate. Regular and reliable attendance. Perform other duties as assigned.

KNOWLEDGE, SKILLS, & ABILITIES

The requirements listed below are representative of the knowledge, skills and/or abilities required.

Education:

High School Diploma or Equivalent Experience:

2 years' experience in healthcare or prior authorizations

Certifications & Licenses:

N/A Technology Applications:

Knowledge of electronic medical records and practice management systems. Proficient in Microsoft Applications. This is an excellent opportunity for a detail-oriented individual with a strong background in medical coding and prior authorization. Join our team and contribute to ensuring that patients receive the necessary medical treatments while navigating the complexities of insurance coverage. Please note that only qualified candidates will be contacted for an interview. We are an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.

Job Type:

Full-time Pay:

$20.00 - $22.00 per hour

Benefits:

401(k) Dental insurance Health insurance Paid time off

Experience:

Insurance verification: 1 year (Required) Medical billing: 1 year (Preferred)

Work Location:

In person