Prior Authorization Specialist

Job Title: Rheumatology Prior Authorization Specialist

Location: Northern Virginia

Job Type: Full-Time

About Us:

NOVA Arthritis and Rheumatology Specialists is a dedicated rheumatology practice committed to providing exceptional care to our patients. We are currently seeking a dedicated and detail-oriented Prior Authorization Specialist to join our team, focusing on securing timely prior authorizations for infusion drugs and ensuring seamless patient access to treatment.

Position Overview

The Prior Authorization Specialist will be responsible for obtaining prior authorization for specialty medications prescribed by our rheumatologists. This position plays a critical role in facilitating treatment access, reducing delays, and ensuring compliance with insurance requirements. The ideal candidate should have a strong understanding of rheumatology-specific medications, insurance guidelines, and prior authorization processes.

Key Responsibilities

• Prior Authorization Requests: Submit and manage prior authorization requests for infusion drugs (e.g., biologics and specialty medications) through insurance platforms.
• Insurance Communication: Communicate with insurance companies to ensure timely approvals and troubleshoot any issues related to prior authorizations.
• Patient Communication: Keep patients informed about the status of their medication approvals and any required steps for coverage.
• Coordination with Infusion Team: Collaborate closely with the clinical and infusion teams to ensure that treatments are scheduled promptly once authorization is obtained.
• Documentation: Maintain accurate records of prior authorization requests, approvals, denials, and any follow-up needed.
• Appeals Process: Assist in gathering documentation and submitting appeals when prior authorization requests are denied.
• Compliance: Ensure all documentation is in accordance with HIPAA and other regulatory requirements.
• Process Improvement: Identify opportunities to streamline prior authorization workflows and reduce delays.

Qualifications

• Education: High school diploma or equivalent required. Associate’s or Bachelor’s degree in healthcare or related field preferred.
• Experience:
• 2 years of experience in prior authorization, preferably within a rheumatology or specialty clinic.
• Familiarity with infusion drugs and rheumatology treatments is highly desirable.
• Knowledge:
• Strong understanding of insurance plans, prior authorization requirements, and appeals processes.
• Familiarity with biologic medications and specialty pharmacies.
• Experience with electronic medical records (EMR) and prior authorization systems (e.g., CoverMyMeds).
• Skills:
• Excellent verbal and written communication skills.
• Strong organizational skills and attention to detail.
• Ability to work in a fast-paced environment and manage multiple priorities.

Benefits

• Competitive salary
• Health, dental, and vision insurance
• 401(k) plan with employer matching
• Paid time off and holidays
• Continuing education and professional development opportunities

How to Apply

Interested candidates should submit their resume and cover letter to management@nova-arthritis.com with the subject line "Prior Authorization Specialist Application."