Prior Authorization Specialist (CMA or Pharm Tech)

Prior Authorization Specialist

Medical Associates is looking for a CMA to join our team as a full-time Prior Authorization Specialist!

Schedule: 8:00am to 5:00pm Monday-Friday. Hours can be flexed, in coordination with other team members' schedules. Opportunity for work from home after training if desired!

Location: Medical Associates Health Plans, 1605 Associates Drive, Dubuque, IA 52002

Full-Time Benefits Package Includes:

• Single or Family Health Insurance with discounted premium rates for wellness program participation.
• 401k with immediate matching (50% on the dollar up to 7% of pay + additional annual Profit Sharing)
• Flexible Paid Time Off Program (24 days off/year)
• Medical and Dependent Care Flex Spending Accounts
• Life insurance, Long Term Disability Coverage, Short Term Disability Coverage, Dental Insurance, etc.

Major Duties and Responsibilities:

• Review prior authorization requests and gather the supporting documentation needed from the medical record.
• Submit requests to payers, monitor status, follow up as needed, and document outcomes.
• Work with providers and clinical staff to obtain missing or additional information needed to support authorization.
• Communicate authorization status and payer requests to providers and staff.
• Recognize when a request requires clinical interpretation, medical necessity review, an appeal, or other nursing judgment and escalate those cases to the appropriate nurse.
• Complete all other assigned projects and duties.

Knowledge and Skills:

Experience: Two or more years of medical office, referral, scheduling, insurance verification, prior authorization, or related healthcare experience preferred.

Education: Equivalent to completion of a specialized course of study or certification at a business or trade school. Must possess a current certification or registration as a Certified Medical Assistant (e.g., CMA through AAMA, CCMA through NHA, or RMA through AMT).

Interpersonal Skills: A significant level of trust and diplomacy is required, in addition to normal courtesy and tact. Work involves extensive personal contact with others and/or is usually of a personal or sensitive nature. Work may involve motivating or influencing others. Ability to work independently and remain motivated in daily work is required. Outside contacts become important and fostering sound relationships with other entities (companies and/or individuals) becomes necessary.

Physical Aspects: Reaching - Extending hand(s) and arm(s) in any direction. Lifting - Raising objects from a lower to a higher position or moving objects horizontally from position-to-position. This factor is important if it occurs to a considerable degree and requires the substantial use of the upper extremities and back muscles. Fingering - Picking, pinching, typing or otherwise working, primarily with fingers rather than with the whole hand or arm as in handling. Grasping - Applying pressure to an object with the fingers and palm. Talking - Expressing or exchanging ideas by means of the spoken word. Those activities in which they must convey detailed or important spoken instructions to other workers accurately, loudly or quickly. Hearing - Perceiving the nature of sound with or without correction. Ability to receive detailed information through oral communication and to make fine discriminations in sound, such as when making fine adjustments on machined parts. Vision - 20 / 40 or better in the best eye with or without correction. Repetitive Motions - Substantial movements (motions) of the wrists, hands and/or fingers. Sedentary Work - Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Environmental Conditions: None - The worker is not substantially exposed to adverse environmental conditions (such as in typical office or administrative work).

Medical Associates Clinic & Health Plans is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, pregnancy, age, national origin, marital status, parental status, disability, veteran status, or other distinguishing characteristics of diversity and inclusion, or any other protected status.