What are the responsibilities and job description for the Medication/Prior Authorization Specialist position at CMU Health?
Join Our Team as a Medication & Prior Authorization Specialist!
Are you a detail-oriented healthcare professional with a passion for streamlining patient care? Do you thrive in fast-paced environments where accuracy and efficiency are key? If so, we want you to join our dynamic outpatient clinic team as a Medication Prior Authorization Specialist!
What You’ll Do:
- Review and process prior authorization requests for medical procedures, tests, medications, and treatments according to insurance guidelines and clinic protocols.
- Verify patient insurance coverage and eligibility for requested procedures or treatments.
- Communicate with insurance companies to obtain necessary authorizations and resolve coverage issues.
- Maintain accurate records of requests, approvals, denials, and appeals, ensuring clear documentation of communication with insurance companies and healthcare providers.
- Provide patients with updates and guidance on authorization requirements and financial responsibilities.
- Collaborate with healthcare providers, nurses, and administrative staff to coordinate patient care and ensure compliance with insurance requirements.
- Prepare and submit appeals for denied authorizations, advocating for patients’ medical needs.
- Stay updated on insurance policies, regulations, and industry trends related to prior authorization processes.
- Identify opportunities for process improvements and efficiency enhancements in prior authorization management.
What You Bring:
- Education: High school diploma required; Associate degree preferred.
- Experience: Minimum of 2 years in prior authorization management in a healthcare setting, preferably in an outpatient clinic or medical office.
- Skills: Excellent communication skills (verbal and written), strong organizational and time management skills, ability to work independently and prioritize tasks effectively.
- Preferred Knowledge: Familiarity with medical billing processes and revenue cycle management is a plus.
Why You’ll Love Working Here:
- Be part of a supportive team that values your skills and dedication.
- Opportunities for professional growth and development.
- A welcoming and inclusive work environment.
Ready to Make a Difference? Apply Now!
CMU is an AA/EO institution, providing equal opportunity to all persons, including minorities, females, veterans, and individuals with disabilities.
