What are the responsibilities and job description for the Medical Prior Authorization Specialist position at MOD Dermatology?
Medical Prior Authorization Specialist
Key responsibilities include:
- Reviewing medical records: Thoroughly examining patient medical history to identify treatments or medications that require prior authorization based on insurance guidelines.
- Verifying insurance coverage: Checking patient insurance benefits to confirm coverage for requested services and identify any limitations or prior authorization requirements.
- Contacting providers: Communicating with physicians, specialists, or pharmacies to gather additional medical information needed for prior authorization requests.
- Submitting prior authorization requests: Initiating the prior authorization process through electronic or paper submissions to the insurance company, including detailed medical justification.
- Following up on requests: Monitoring the status of pending prior authorization requests and contacting the insurance company to resolve any issues or delays.
- Denial management: Addressing denied prior authorization requests by providing additional information or appealing the decision when appropriate.
- Maintaining accurate records: Documenting all prior authorization activities in patient records, including dates, communication details, and approval status.
Required skills:
- Medical terminology: Strong understanding of medical terminology to accurately interpret patient medical records.
- Insurance knowledge: Familiarity with different health insurance plans, coverage details, and prior authorization protocols.
- Clinical understanding: Basic knowledge of medical conditions, treatments, and medication interactions.
- Communication skills: Excellent verbal and written communication to interact with providers, insurance companies, and patients.
- Attention to detail: Ability to carefully review medical records and insurance information to ensure accuracy in prior authorization requests.
- Computer proficiency: Efficient use of electronic health records (EHR) systems and prior authorization platforms.
Job Type: Full-time
Pay: $20.00 - $22.00 per hour
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Ability to Commute:
- Omaha, NE 68130 (Required)
Ability to Relocate:
- Omaha, NE 68130: Relocate before starting work (Required)
Work Location: In person
Salary : $20 - $22