What are the responsibilities and job description for the Prior Authorization Specialist - Northwest position at Gonzaba Medical Group?
General Summary: Provides support to the family practice department by processing all medication Prior Authorization requests. Utilizes Athena and Cover My Med Portal to process prior authorizations. Reviews medical record documentation in order to obtain medical justification for new medications and or DME prescribed by the providers. Communicates with pharmacies and patients as needed.
Supervisory Responsibilities: This position has no supervisory responsibilities.
General Requirements: All duties performed will be done accurately and in a timely manner.
1. Assumes responsibility for maintaining clinical competencies according to Gonzaba Medical Group policy.
2. Ensures customer service is always maintained at the highest level.
3. Exercise tact and courtesy when dealing with patients, visitors, providers, and co-workers.
4. Must always adhere to customer service expectations including in-person and virtual (via telephone, or telehealth applications) communication.
5. Participates in educational programs as needed.
6. Provides leadership, direction, and support to medical assistants’ and LVNs’ on the issues of outpatient care, medications, or scheduling.
7. Assist different teams as necessary including performing the duties of other personnel as needed.
8. Maintain strict confidentiality by adhering to all HIPAA rules and regulations.
9. Other duties as assigned.
Essential Job Responsibilities:
1. Collaborates with patients, pharmacies, insurance providers, the CoverMyMeds portal, and pod staff to facilitate the processing of prior authorization requests. Additionally, handles the access and processing of Right Fax Prior Authorization requests.
2. Handle walk-in patients' and telephonic refill requests and provide assistance to those seeking updates on prior authorization requests.
3. Collaborate with Medication Adherence Team to help improve medication adherence metrics.
4. Manage Prior Authorization schedule for prior authorization or refill needs.
5. Phone patients as needed regarding results, changes in medication, dosage, and other information provided by the provider.
Work Environment: Clinic environment. Exposure to communicable diseases, bodily fluids, toxic substances, ionizing radiation, medicinal preparations, and other conditions common to a clinic environment.
Mental / Physical Requirements: Requires manual dexterity, sitting, standing, stooping, reaching, kneeling, crouching, bending, walking, lifting up to 40 lbs. without assistance. Close vision and ability to adjust focus. Must be able to work efficiently under pressure.
Additional Information: Gonzaba Medical Group is seeking team members who contribute as A-Players, demonstrate a strong work ethic, are committed to the culture and our core values.
Other Duties As Assigned: The above job description is not intended to be an all-inclusive list of duties and standards of the position. Team members will follow any other instructions, and perform any other related duties, as assigned by their supervisor. Responsibilities, knowledge, skills, abilities, and work environments may change as needs evolve.
Qualifications:Education and Training: Minimum high school education or equivalent. Applicants must hold a certificate from an accredited medical assistant school or possess equivalent medical training. CPR certification with AED is required and must be kept current. National certification as a Registered or Certified Medical Assistant is required as initial and continued employment at Gonzaba Medical Group is contingent upon this credential.
National Certification must be issued from one of the following associations: AAMA - Certified Medical Assistant (CMA); ARMA - Registered Medical Assistant (RMA); NAHP - Nationally Registered Certified Medical Assistant (NRCMA); or other association approved by GMG Human Resources.
Experience: Experience in a clinic, doctor’s office or hospital with a minimum of one-year experience preferred.
Other Requirements: Computer Skills: Skilled in use of computer/EMR systems. Knowledge of Word processing software, spreadsheet software, Internet, and database software.