What are the responsibilities and job description for the Prior Authorizations Specialist position at EMERALD IV THERAPY LLC?
ALL FULL TIME EMPLOYEES ARE ELIGIBLE FOR A 100% EMPLOYER PAID HELATH PLAN!
AMERICAN MEDICAL GROUP IS GROWING AND ARE NEEDING SOME ADDITIONAL PRIOR AUTHORIZATION SPECIALISTS
Key Responsibilities
Insurance Authorizations & Verification
- Obtain prior authorizations for GI procedures (e.g., colonoscopies, endoscopies, ERCP, capsule endoscopy) and imaging as required.
- Process authorizations for GI related medications, including biologics and specialty prescriptions.
- Verify insurance benefits, coverage limits, copays, deductibles, and pharmacy benefits.
- Track and monitor authorization status, ensuring approvals are received before scheduled procedures.
Clinical Documentation Support
- Review provider orders and clinical notes to ensure documentation meets insurance requirements.
- Request additional documentation from providers when needed.
- Accurately enter authorization information into the EMR system.
Communication & Coordination
- Communicate authorization outcomes to patients, providers, schedulers, and pharmacies.
- Work closely with the scheduling team to prevent appointment delays.
- Contact insurance companies for updates, clarifications, and peer-to-peer requests.
Administrative Duties
- Maintain detailed logs of pending and completed authorizations.
- Manage denials and initiate appeals when appropriate.
- Ensure compliance with HIPAA and all medical privacy regulations.
- Maintain up to date knowledge of insurance policies, formularies, and GI specific treatment guidelines.
Qualifications
- High school diploma or equivalent.
- Prior experience in medical office operations, insurance verification, or prior authorization preferred
- Knowledge of medical terminology and understanding of GI procedures and medications is desirable
- Strong computer skills; proficiency with EMR systems and authorization portals.
- Excellent written and verbal communication skills.
- High attention to detail and ability to multitask in a fast-paced environment.
Preferred
- Experience working in a Gastroenterology practice or specialty medical office.
- Familiarity with specialty medications (e.g., biologics) and specialty pharmacy processes.
- Certified Medical Assistant (CMA), Certified Professional Biller (CPB), or similar credentials.