Prior Authorization Coordinator

Overview

Job Description

The Prior Authorization Representative is responsible for initiating and assisting patients and clinic with all prior authorizations, direct contact to patients with information on medications including biologics. This role serves as the initial patient contact for patient prescription refill requests and acute medical issues. In addition to these daily patient care duties, additional responsibilities include preparing all necessary paperwork required by biologic medications, submitting to insurances to obtain approval for prescribed medication, and ensuring timely delivery for patient. The Prior Authorization Rep will work closely with both physicians and pharmaceutical representatives to stay up to date on proper treatment plans and drug information.

Responsibilities

• Responsible for initiating all prior authorizations for biologics.
• Communicate with patients on all medication approvals and denials.
• Document in the medical record all communication with patients in regards to medication.
  
  

-Schedule and coordinate patient appointments following company protocol, provider’s treatment plans and medication intervals.-

• Obtain necessary clinical information from the medical record and provider to process prior authorizations
• Ensure all medications have been received prior to patient’s appointment.
• Coordinate meetings with pharmaceutical representatives to discuss biologics in detail and discuss the proper channels to ensure patient receives biologics in a timely manner.
• Adherence to compliance and completion of compliance training.
• Performs other related duties as assigned.
• Track/Monitor laboratory values
  
  

Qualifications

aEducation

High School Diploma

Medical Assistant certification or experience

Prior Authorization Experience Required

Patient Care Experience

Medical Office Experience

Knowledge, Skills And Abilities

Must be detail oriented.

Must have excellent communication skills and the ability to communicate effectively orally and in writing.

Demonstrated leadership experience. Must be able to demonstrate leadership by serving as an example to others with regard to professional behavior, handling multiple tasks, maintaining a positive attitude, and in response to organizational change.

Proficiency with Microsoft Word, Excel and PowerPoint is required. Must be able to learn new software quickly.

Must possess excellent leadership, organizational, and computer skills.

Ability to work effectively and cooperatively with staff, board, clients, and the public.

Ability to multi-task, prioritize appropriately, and work well both individually and as part of a team.

Ability to use time productively and contribute to high levels of company operational efficiency and effectiveness

Physical Demands

• Ability to communicate in an active multi-office environment.
• Ability to efficiently operate all job related office equipment (telephone, computer, calculator, fax, copier).
• Ability to communicate via telephone.
• Ability to sit for large portions of a workday.
  
  

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