Clinical Prior-Authorization Specialist - CMA

Prior Authorization Job Purpose

Assists patients in prior authorization process, including reviewing of medications and imaging orders. Helps patients by providing information, services, and assistance.

DUTIES INCLUDE, BUT ARE NOT LIMITED TO THE FOLLOWING

• Receives new medication and medication refill requests for authorization review.
• Obtains verbal authorizations and requests detailed clinical information from prescribers.
• Approves coverage determination requests based on defined criteria within the scope of approved protocols.
• Contacts insurance companies to obtain prior authorization on medications and documents coverage determination in patient’s electronic medical record.
• Obtains prior authorization on imaging orders.
• Monitors and responds to electronic refill requests and ensures each refill is documented in the patient’s chart.
• Communicate pertinent information to prescribing provider and/or pharmacy.
• Secures patient information and maintains patient confidence by completing and safeguarding medical records.
• Completes diagnostic and procedure coding as required/needed.
• Counsels patients by transmitting physician's orders and questions about medication.
• Maintains safe, secure, and healthy work environment by establishing and following standards and procedures; complying with legal regulations.
• Familiar with standard concepts, practices, and procedures within the medical field including basic medical terminology.
• Practices safe habits including but not limited to infection control, lifting procedures, etc.
• Presents a professional image and customer focus.
• Practices teamwork by helping others willingly and communicating in a professional manner.
• Keeps equipment operating by following operating instructions; troubleshooting breakdowns; maintaining supplies; performing preventive maintenance; calling for repairs.
• Updates job knowledge by participating in educational opportunities; reading professional publications.
• Serves and protects the practice by adhering to professional standards, policies and procedures, federal, state, and local requirements.
• Operates standard office equipment (e.g. copier, personal computer, fax, etc.).
• Has regular and predictable attendance.
• Adheres to Advanced Pain Care’s Policies and procedures.
• Performs other duties as assigned.

Requirements

MINIMUM QUALIFICATIIONS

• Education : Requires a high school diploma or GED
• Experience : One or more years preferred, Certified Medical Assistant required

KNOWLEDGE AND SKILLS : Clear and precise communication, knowledge of medical terminology, effectively manages day by organizing and prioritizing, applies tactful principles and practices of dealing with the public, practices safety, and protects patient information and maintains confidentiality

BENEFITS : Full Time Position with Great Benefit package (Life, Medical, Dental, Vision, Retirement, PTO, Gym Membership, and other supplemental options)