Prior Authorization Specialist

About the Company:

Capital Internal Medicine Associates PC (CIMA) is a physician owned medical practice with five locations across Greater Lansing serving primary care, OB-GYN, and internal medicine. At CIMA, our focus is on providing individualized care to our patients. We are committed to excellence in providing quality, cost effective, compassionate and personalized health care.

POSITION SUMMARY

The position is responsible for ensuring that patients receive the medication that requires pre-authorizations from insurance carriers. This position is also responsible for receiving prescriptions, addressing and rectifying rejected claims and addressing necessary third party authorization requests.

ESSENTIAL JOB FUNCTIONS

• Assists with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed.
• Collaborate with clinical staff as well as providers to assist in obtaining pre-authorizations in a cross functional manner.
• Review accuracy and completeness of information requested and ensure that all supporting documents are present.
• Communicate with insurance carriers regarding medications allowed based on the carriers formularies and then communicate with providers, clinical staff, and patients regarding medications approved on the formulary.
• Receive requests for pre-authorizations and ensure that they are properly and closely monitored.
• Monitor outstanding authorization requests and initiate follow-up of outstanding authorizations in a timely manner.
• Submit medical records to insurance carriers to expedite prior authorization process.
• Manage correspondence with insurance carriers, providers, clinical staff, and patients as required.
• Look through denials and submit appeals in an effort to get them approved by insurance carriers.
• Ensure pre-authorization information is properly updated in the patients’ electronic medical record (EMR).
• Monitor and submit annual authorization renewals as needed for patients.
• Handle telephone requests timely and accurately.
• Coordinate medical reviews between insurance carriers and nurses, as necessary.
• Communicates with patient for status updates at reasonable intervals.
• Facilitates peer to peer interaction when necessary.
• Secure patients’ demographics and medical information by using great discretion and ensuring that all procedures are in sync with HIPPA compliance and regulation.
• Performs other duties as assigned.

NON-ESSENTIAL JOB FUNCTIONS

• Reloads paper and replaces toner in copier, printer, fax machine or other office equipment to ensure supply levels are maintained throughout the workday.

EDUCATION/EXPERIENCE REQUIRED

Must have high school diploma or GED.

Successful graduation from an accredited medical assisting program or three (3) years’ experience in a healthcare setting, dealing with insurance carriers.

Prior medical assistant experience is preferred

PHYSICAL REQUIREMENTS

• Regularly expresses or exchanges ideas to deliver and/or receive information between self and patients, clinicians, co-workers and/or others accurately, usually quickly, and typically using speaking, hearing, and/or keyboarding, reading. (6-8 hours daily).
• Prolonged periods of working on a computer and using a telephone. Often moves about within a general office environment.
• Must be able to lift up to 25 pounds infrequently.

Capital Internal Medicine Associates, P.C. is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, gender identity, sexual orientation, age, status as a protected veteran, or status as a qualified individual with a disability.

Benefits:

• 401(k)
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Work Location: In person

Salary : $36,695 - $46,739