Prior Authorization Specialist (CMA)

Job Description

Job Description

We are a busy Gastroenterology office with 33 Providers. We are looking for a team-oriented individual to provide great customer service to our patients! This individual should show great attention to detail and a passion for healthcare.

We are currently expanding our Practice by adding additional providers and several more procedure rooms! We are looking to bring on additional team members to help accommodate for the increased number of patients we will be seeing!

JOB TITLE: Prior Authorization Specialist (Certified Medical Assistant)

JOB SUMMARY: Performs insurance prior authorizations necessary for appointments, procedures, medications, etc. Performs chart checks and maintains log for chronic care management. Works collaboratively with every nurse team, provider, and other departments as assigned to provide exceptional patient care.

PRINCIPLE DUTIES AND RESPONSIBILITIES:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee. Duties, responsibilities, and activities may change at any time with or without notice.

ESSENTIAL JOB FUNCTIONS:

1. Obtains prior authorization from patient’s insurance regarding upcoming appointments, procedures, radiology orders, medications prescribed, etc.
2. Assists with educating other departments regarding necessary information to gather from patients or insurance companies to ensure proper documentation for the prior authorization process.
3. Works collaboratively with each provider and nurse team, as well as the billing and verifications teams, to obtain any information necessary to properly obtain prior authorization.
4. Fully documents prior authorization process as necessary in the patient’s chart.
5. Performs chart checks and helps maintain a log for chronic care management.
6. Maintains patient confidentiality.
7. Demonstrates good communication and interaction skills when dealing with supervisors, co-workers, patients, families, and other departments.
8. Follows appropriate infection control policies and procedures of facility and regulatory agencies.
9. Maintains knowledge of and adheres to established organizational and departmental policies and procedures.
10. Participates in organizational and departmental goals and performance improvement activities.
11. Participates in personal and professional growth by attending in- services/educational workshops and scheduled departmental meetings.
12. Organizes and prioritizes work to complete responsibilities according to plan within established time frames.
13. Keeps punctual and regular attendance.
14. Performs other tasks and special assignments as directed by the supervisor.

PERFORMANCE REQUIREMENTS:

KNOWLEDGE, SKILLS & ABILITIES: Knowledge of medical insurance processes and procedures. Knowledge of the principles of patient care and the ability to interpret medical records and documentation as necessary. Ability to maintain patient confidentiality. Knowledge of common safety hazards and precautions to establish a safe work environment. Skills and abilities in developing and maintaining department quality assurance and control standards. Ability to interpret, adapt, and apply guidelines and procedures. Ability to read, understand, and respond to detailed oral and written instruction. Skill in operating a computer, photocopier, fax machine, and other technology typical of an office environment. Ability to communicate clearly. Skills to establish and maintain effective working relationships and communication with patients, medical staff, and the public. Required ability to work in a caring and kind manner under high stress with patients who are irritable or confused.

EDUCATION: High school diploma or equivalent required. Graduation from an accredited program for Medical Assistants preferred.

EXPERIENCE:

1. Three (3) years’ experience in medical/surgical setting or in a medical office required.
2. Two (2) years’ experience with insurance prior authorization preferred.

CERTIFICATE/LICENSURE: A current and valid Nebraska license as a Medical Assistant.

SCHEDULE: Monday through Thursday with a start time between 7:30am - 8:00am and an end time between 4:30pm - 5:00pm. Fridays between 7:30am/8:00am until 12:30pm. This position would have most Friday afternoons off! This position would have the opportunity to work a hybrid role remote/in-office after a 6-month training period.

Expected Hours: 36-40 hours/week

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible schedule
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Parental leave
• Referral program
• Vision insurance

Medical Specialty: Gastroenterology

Physical Setting: Medical Office, Clinic, Private practice

Supplemental Pay:

• Overtime pay
• Retention bonus