What are the responsibilities and job description for the Prior Authorization Specialist position at Advanced Pain Care?
Job Description
Job Description
Description :
Prior Authorization Job Purpose : Assists patients in prior authorization process, including reviewing of medications and imaging orders. Helps patients by providing information, services, and assistance.
DUTIES INCLUDE, BUT ARE NOT LIMITED TO THE FOLLOWING
- Receives new medication and medication refill requests for authorization review.
- Obtains verbal authorizations and requests detailed clinical information from prescribers.
- Approves coverage determination requests based on defined criteria within the scope of approved protocols
- Contacts insurance companies to obtain prior authorization on medications and documents coverage determination in patient’s electronic medical record.
- Obtains prior authorization on imaging orders.
- Monitors and responds to electronic refill requests and ensures each refill is documented in the patient’s chart.
- Communicate pertinent information to prescribing provider and / or pharmacy.
- Secures patient information and maintains patient confidence by completing and safeguarding medical records.
- Completes diagnostic and procedure coding as required / needed.
- Counsels patients by transmitting physician's orders and questions about medication.
- Maintains safe, secure, and healthy work environment by establishing and following standards and procedures; complying with legal regulations.
- Familiar with standard concepts, practices, and procedures within the medical field including basic medical terminology.
- Practices safe habits including but not limited to infection control, lifting procedures, etc.)
- Presents a professional image and customer focus.
- Practices teamwork by helping others willingly and communicating in a professional manner
- Keeps equipment operating by following operating instructions; troubleshooting breakdowns; maintaining supplies; performing preventive maintenance; calling for repairs.
- Updates job knowledge by participating in educational opportunities; reading professional publications.
- Serves and protects the practice by adhering to professional standards, policies and procedures, federal, state, and local requirements.
- Operates standard office equipment (e.g. copier, personal computer, fax, etc.).
- Has regular and predictable attendance
- Adheres to Advanced Pain Care’s Policies and procedures
- Performs other duties as assigned.
Requirements :
SUPERVISION Reports to Location Manager
MINIMUM QUALIFICATIIONS
Education : Requires a high school diploma or GED, and certified medical assistant certificate
Experience : None required, but two or more years preferred
WORKING CONDITIONS
Environmental Conditions : Medical Office environment
Physical Conditions :
KNOWLEDGE AND SKILLS
