Prior Authorization Specialist - Medical

Primary Job Functions

•  Responsible for reviewing, submitting, monitoring, and responding to issues regarding medication prior authorizations.
•  Reviews patient medical history to identify supporting documentation in the patient chart relevant to the medication.
• Professionally communicates with prescribers, practice support staff, patients, and representatives of insurance companies; includes oral and written communication.
• Responsible for contacting insurance companies via appropriate method to obtain prior authorization.
• Updates information in the patient medical record with approval or declination information; follows up with ordering physician as to status of prior authorization.
• Efficiently tracks pending authorizations for multiple offices/prescribers.
• Creates a positive, professional, service-oriented work environment for staff, patients, and family members by supporting the mission and values of OGG.

Secondary Job Functions:

•  Maintain confidentiality of patient and financial information by utilizing HIPPA guidelines and regulations.
• Responsible for reviewing, submitting, planning, and tracking of referrals made by clinic providers.
• Adheres to all Federal, State, and Local laws and regulations as well as policies.

Knowledge, Skills, and Abilities

• Knowledge of third-party payers and prior authorization requirements
• Understanding of basic medical terminology and medications
• Proficient use of office equipment, such as copier, fax machine, phones, etc.
• Intermediate computer skills including use of Microsoft Office (Excel and Word), electronic mail, payer websites, physician practice management, and electronic medical record systems.
• Strong time management skills
• Ability to work independently with minimal supervision and to manage multiple priorities.

Credentials and Experience 

• Must have a high school diploma or equivalent. 
• One (1) year of experience and relevant knowledge of insurance eligibility or prior authorization in a healthcare setting preferred. 
• Certified pharmacy technician, certified medical assistant, or licensed practical nurse preferred.