Prior Authorization Coordinator

Prior Authorization Specialist

Under general direction, provides quality patient care to patients regarding Prior Authorizations and general medication inquiries. Responsibilities include, obtaining prior-authorizations, following up and communicating with patients as to the status of their prior-authorization, and working with insurance companies, pharmacy phone calls and patient calls related to medication issues.

Essential Duties and Responsibilities:

• Performs job in accordance with Company Mission, vision, and goals.
• Exercises confidentiality in all areas; abiding by HIPAA rules and regulations.
• Accurately completes applicable documentation as required for the completion of prior-authorizations.
• Prepares all forms and requisitions as need by insurance companies and pharmacies.
• Follows through to ensure that all prior-authorizations are submitted in a timely manner and followed up on within 72 business hours.
• Obtains prior-authorization for prescriptions.
• Monitors and maintains the task buckets associated with prior-authorizations and medication issues.
• Ensures accuracy of all forms submitted to the insurance companies and pharmacies.
• Provides professional and courteous customer/patient care; displaying knowledge and enthusiasm for the treatment approach.
• Expedites service in situations requiring urgent attention to medications and prior authorizations.
• Maintains high-level of product and service knowledge.
• Identifies opportunities for process improvement and contributes to solutions to enhance workflow efficiency and the customer's/patient's experience.
• Communicates medication denials and medication issues, as well as next steps, to appropriate staff.
• Checks work e-mail on a regular basis throughout the workday.
• Participate in and complete all required trainings and in-services.
• Other duties as assigned.

Minimum Qualifications:

• High School Diploma or equivalent.
• At least two (2) years of related experience working as a Medical Assistant or Nursing Assistant.
• Must have knowledge of Internet and Microsoft Office software (MS Word, MS Excel, MS PowerPoint, MS Outlook).
• Must have excellent written and oral communication skills.
• Must be able to work individually as well as within a team.
• Must be able to multi-task and prioritize.
• Must demonstrate extreme attention to detail.
• Must possess strong organization skills.
• Must be able to perform calculations, problem solve and use reasoning.
• Must have knowledge of medical practices and medical terminology.
• Must be able to meet predefined production and quality standards.
• Must be able to effectively manage and direct others.
• All staff are expected to have a strong desire to provide excellent customer service; to comply with the rules and regulations of those organizations to which we are accountable; to have high ethical and professional standards of conduct; and to have an attitude of wanting to continuously improve their own professional performance.

Preferred Qualifications:

• Associates Degree from an accredited college.
• One (1) year of clinical expertise in the pain management field.
• One (1) year of prior experience working with an Electronic Medical Record (EMR).

The employee must have reliable transportation. While the primary workplace may be closest to the employee's home, work assignments could be in any of the Company's locations.

Compensation and Benefits:

• Pay Range : $18.00/hr - $21.00/hr
• PTO : Up to 96 hours in first year (pro-rated based on start date)
• Holidays : 7 (New Year's Day, Memorial Day, Independence Day, Labor Day, Thanksgiving, Day After Thanksgiving, Christmas Day)
• Retirement : 401(k) with employer match
• Health Benefits : Medical (single and family), Dental (single and family), Vision (single and family)
• Other Company-Paid Benefits : Short-Term Disability, Long-Term Disability, Basic Life/AD&D, Employee Assistance Program
• Other Voluntary Benefits : Voluntary Life, Accident, Critical Illness, Hospital Indemnity
• Other Compensation : This position is non-exempt (hourly) and eligible for overtime pay in accordance with applicable law. Overtime is not guaranteed. This position is not eligible for bonus, commission, incentive, or shift differential pay.