Prior Authorization Representative

Description:

Job Summary
The Treatment & Authorization Representative serves as the primary point of contact for patients following diagnosis by communicating pathology results, educating patients on provider-recommended treatment plans, coordinating follow-up care, and obtaining insurance authorizations for prescribed medications and treatments. This position works closely with providers, patients, pharmacies, and insurance carriers to ensure timely access to treatment while delivering compassionate patient care, exceptional customer service, and accurate clinical documentation.

Primary Responsibilities

Patient Treatment Communication

• Contact patients with pathology test results and communicate both normal and abnormal findings with professionalism and compassion.
• Explain provider-recommended treatment plans and answer patient questions within scope.
• Schedule procedures, surgeries, follow-up appointments, or additional treatment as directed by providers.
• Provide education regarding medications, procedures, and next steps in the patient's treatment plan.
• Document all patient interactions accurately in the electronic medical record (EMR).

Prior Authorizations & Insurance

• Process prescription prior authorizations for medications, including biologic therapies and specialty medications.
• Submit clinical documentation and medical necessity information to insurance carriers.
• Monitor authorization requests and follow up to ensure timely approvals.
• Review denials and complete appeals as requested by providers.
• Maintain accurate authorization documentation, approval dates, expiration dates, and authorization numbers.
• Proactively renew authorizations to prevent interruptions in patient treatment.

Patient Care & Collaboration

• Serve as a liaison between patients, providers, pharmacies, and insurance companies.
• Maintain knowledge of dermatology treatments, pathology terminology, and insurance authorization requirements.
• Communicate professionally with internal departments to coordinate patient care.
• Deliver outstanding customer service while maintaining empathy and professionalism during sensitive conversations.
• Ensure compliance with HIPAA, OSHA, and organizational policies.
• Perform other duties as assigned.

Qualifications

Education & Experience

• Medical Assistant certification or equivalent clinical experience preferred.
• Dermatology experience strongly preferred.
• Prior authorization experience preferred; biologics experience is a plus.
• Strong understanding of medical terminology.
• Excellent communication, organization, and customer service skills.
• Ability to multitask and prioritize in a fast-paced environment.
• Experience with EMR systems and Microsoft Office applications.

Working Hours:

Monday- Thursday (or) Tuesday- Friday: 8:00 - 5:00

* Hire will be working five days a week with *one day working from home

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