Description

Summary:

The Prior Authorization Specialist will obtain prior authorizations for prescription medications, some durable medical equipment, and referral authorizations for some specialist appointments. This position will secure the prior authorization and notify the rendering party in the timeliest manner possible, so our patient receives the services needed with the least delay.

Location:

Columbus, GA; Talbotton, GA, Fortson, GA

Salary:

$33,206-$49,809

Duties and Responsibilities:

• Receive requests for prior authorizations through the electronic health record (EHR) and/or via phone or fax and ensure that they are properly and closely monitored. 
• Process referrals and submit medical records to insurance carriers to expedite prior authorization processes. 
• Follow up on missing or incorrect information so patients receive the right reimbursement. Manage correspondence with insurance companies, physicians, specialists, and patients as needed, including documenting in the EHR as appropriate. 
• Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed. 
• Review accuracy and completeness of information requested and ensure that all supporting documents are present. 
• Review denials and follow up with provider to obtain medically necessary information to submit an appeal of the denial. 
• Prioritize the incoming authorizations by level of urgency to the patient. 
• Secure patient information in accordance with HIPPA policy/procedures. 
• Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision 
• Assist with other pharmacy-related duties as needed (e.g., 340B referral capture, prescription input) 
• Weekend and Extended Hour Staffing required. 
• Other duties as assigned. 

Evaluation: The evaluation of work performance, including specific duties, responsibilities, demeanor, and work ethic, will be ongoing and implemented by the CEO per center policies. 

Requirements

Minimum Qualifications:

• High school diploma or GED
• Certificate of Pharmacy Technician
• Successful completion of a pharmacy training course or the equivalent skills acquired through informal training and experience.
• Must successfully pass a drug screening and a criminal background check.
• Previous experience in a clinic setting preferred. 
• Knowledge of insurance process and medical terminology preferred. 
• Prior experience with Cover My Meds platform, preferred 
• Prior experience with 340B referral capture, preferred 
• Completion of 340B University and/or Advanced 340B Operations Certificate (ACE), preferred 

Physical Requirements:  

• Prolonged periods of sitting at a desk and working on a computer. 
• Must be able to lift up to 15 pounds at times.
• Compliance: Adhere to company policies and procedures and all Federal, State and Local medical service requirements. To include HIPAA Privacy & Security. 

Confidentiality (HIPAA): Every employee is required to sign a Pledge of Confidentiality. Failure to comply with our Pledge of Confidentiality can or will lead to immediate termination of employment. Confidentiality applies to a patient’s Personal Health Information (PHI) and includes written, oral, and electronic communications. Each employee has an obligation to maintain confidentiality after their employment/association with this facility ends.

Security (HIPAA): Every employee is required to protect their computer log-on and password. You must secure your work area before leaving it unattended for a long time. You must log off your computer and secure your work area before leaving at the end of the day. If you are responsible for closing or locking files, securing equipment, or locking the building and do not comply with these requirements, you will be subject to reprimand and/or termination based on the infraction. We are required by law to protect patient privacy, identifiable patient information, and all properties containing such information. 

Environmental Working Conditions: This position includes both administrative and medical responsibilities. Employees are frequently exposed to communicable diseases, toxic substances, medical cleaning, and processing solutions which may include ionizing radiation plus other elements common in a clinical environment. 

Our company is a proponent of diversity, and we welcome applicants from various faith systems and orientations. Our company strives to hire candidates with the highest potential, regardless of race, culture, belief, or sexual orientation. As an Equal Opportunity Employer, we take pride in having a diversified workforce.