Prior Authorization Assistant (Clinic)

Position Summary:  Ensure that prior authorizations are complete, accurate and current in order for patients to receive their medications in a timely manner that does not delay treatment.   

Responsibilities of Position: 

• Submit authorizations for prescription medications ordered in the employed department for all medical insurances and no-fault (if applicable). 
• Review documents (D) jelly bean multiple times throughout shift to perform prior auth submission through appropriate website (i.e. Cover My Meds)
• If there is a day(s) working remote, communicate and send any prior auth requests to a nursing team member in the office to print, perform and submit via electronic fax.  
• Perform training for operational teams to ensure quality goals are met.
• Communicate to payers if there is issue with prior authorization and resolve effectively and efficiently. 
• Follow payor formulary guidance to submit information to insurance companies to gain approval of patient’s medication.
• Other duties as assigned and requested

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Skills & Experience Necessary

• Preferred healthcare experience; not mandatory
• Word, Excel and EMR experience; eCW preferred.
• Strong attention to detail and problem solving
• Good communication skills and ability to work with a team to accomplish goals
• Self-directed, self-motivated to accomplish work.

Required Education 

Working Conditions:

• Sedentary work – sitting majority of shift
• Walking and standing are required only occasionally
• Ability to sit at a computer terminal for majority of shift
• Requires use of hands and fingers to operate computer and telephone keyboard
• OSHA Category III - Normal routine involves no exposure to blood, body fluid or tissue and as part of their employment, incumbents are not called upon to perform or assist in emergency care or first aid
• Position Summary:  Ensure that prior authorizations are complete, accurate and current in order for patients to receive their medications in a timely manner that does not delay treatment.   

   

  Responsibilities of Position: 

  • Submit authorizations for prescription medications ordered in the employed department for all medical insurances and no-fault (if applicable). 
  • Review documents (D) jelly bean multiple times throughout shift to perform prior auth submission through appropriate website (i.e. Cover My Meds)
  • If there is a day(s) working remote, communicate and send any prior auth requests to a nursing team member in the office to print, perform and submit via electronic fax.  
  • Perform training for operational teams to ensure quality goals are met.
  • Communicate to payers if there is issue with prior authorization and resolve effectively and efficiently. 
  • Follow payor formulary guidance to submit information to insurance companies to gain approval of patient’s medication.
  • Other duties as assigned and requested

• Other Duties

  Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

   

  Skills & Experience Necessary

  • Preferred healthcare experience; not mandatory
  • Word, Excel and EMR experience; eCW preferred.
  • Strong attention to detail and problem solving
  • Good communication skills and ability to work with a team to accomplish goals
  • Self-directed, self-motivated to accomplish work.
    
    Required Education 
  • High School Diploma
  
   
  Working Conditions:
  • Sedentary work – sitting majority of shift
  • Walking and standing are required only occasionally
  • Ability to sit at a computer terminal for majority of shift
  • Requires use of hands and fingers to operate computer and telephone keyboard
  • OSHA Category III - Normal routine involves no exposure to blood, body fluid or tissue and as part of their employment, incumbents are not called upon to perform or assist in emergency care or first aid