Prior Authorization Specialist

SUMMARY:

The Prior Authorization Specialist will contact insurance companies, on behalf of Brown Dermatology, to verify patient specific benefits and authorizations/referrals for medications, including biologics, and treatments as required by the insurance carrier. The Prior Authorization Specialist will ask appropriate questions regarding patient’s benefits and complete data entry and/or appropriate forms to document patient’s benefits coverage. The Prior Authorization Specialist may be asked to work denials on the authorizations that had been obtained.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

Consistently applies the Brown Dermatology’s values of patient care priority, dignity, collaboration, integrity and quality in support of our mission to deliver compassionate, high-quality patient care, research excellence and outstanding physician education. Responsible for knowing and acting in accordance with the Brown Dermatology’s Compliance Program and Code of Conduct.

Consistently practices the Brown Dermatology’s Customer Service Standards.

• Work closely with the Practice Manager and nursing and pharmacy teams to ensure that all medication and treatment authorizations are documented completely and submitted in a timely manner
• Communicate authorization denials to ordering physicians
• Prioritize and organize all prior authorization activities
• Serve as a liaison between patient, insurer, and practice
• Work on denials and write offs
• Obtain forms and appropriate documentation to help patients get on any assistance program in event of a denial; serves as point of contact between patient and applicable bridge programs
• Prepare written communication to notify appropriate staff of authorization updates and or changes for insurance carrier
• Schedule peer-to-peer discussions if medications/treatments prior authorizations are denied.
• Keep track of pending authorization until decision is made.
• Contact insurance companies to obtain prior authorization via telephone and/or portals and provides necessary clinical documentation to ensure authorization is obtained prior to the scheduled treatment and/or retroactively as needed
• Perform other duties as assigned by Practice Manager.

BASIC KNOWLEDGE:

• High school diploma or equivalent required
• Ability to deal tactfully and effectively with patients, family members, staff members, and physicians
• Excellent customer service and communication skills
• Ability to represent the organization and serve consumers in a professional manner and promote a positive image of the organization and its services.

EXPERIENCE:

• Minimum of one year of previous medical assistant experience required
• One to two years of experience with prior authorization process preferred
• eClinicalWorks experience preferred.

WORKING CONDITIONS AND PHYSICAL REQUIREMENTS:

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Conditions common to a clinical practice environment. Involves frequent contact with patients and other customers. Interaction with others is constant and interruptive. Work may be stressful at times.

INDEPENDENT ACTION:

Work is performed under general supervision, with some independent judgment exercised in determining priorities.

SUPERVISORY RESPONSIBILITY:

None.

EOE/F/M/Vet/Disabled

Employees are required to be vaccinated against COVID as a condition of employment, subject to accommodation for medical exemptions.