MEDICAL ASSISTANT

Department: Prior Authorization Department

Reports To: Prior Authorization Manager

The Prior Authorization Medical Assistant is responsible for managing the prior authorization and patient assistance processes for medications across South Central’s primary care and specialty clinics. This role ensures timely access to prescribed medications by coordinating with healthcare providers, insurance companies, and drug manufacturers, while also helping patients qualify for and remain on drug assistance programs when applicable.

Key Responsibilities:

• Prior Authorization Process: Manage and complete prior authorization requests for medications, collaborating with primary care and specialty providers to gather necessary clinical documentation and submit requests to insurance companies.

• Patient Drug Program Management: Establish and maintain patients on pharmaceutical manufacturer drug programs, assisting them in completing enrollment forms, meeting program criteria, and ensuring continued eligibility.

• Collaboration with Providers: Work with physicians, nurse practitioners, and clinic staff to provide all required information for medication authorizations and drug program enrollments.

• Insurance and Manufacturer Communication: Liaise with insurance providers and drug manufacturers to facilitate prior authorizations and ensure patients have access to necessary medications.

• Documentation: Maintain accurate records of all prior authorization and drug program activities, including approvals, denials, follow-ups, and patient communications.

• Patient Support: Communicate with patients about the status of their medication authorizations and drug program enrollments, explaining coverage details, alternative medications, and program guidelines.

• Follow-up and Appeals: Monitor the progress of prior authorization requests and drug program applications, managing appeals as necessary and ensuring that patients remain enrolled in manufacturer programs as long as they are eligible.

• Compliance: Adhere to HIPAA regulations and ensure compliance with all legal requirements regarding patient information and medication access processes.

• Team Collaboration: Work closely with pharmacy services, billing departments, and clinical teams to streamline workflows for both prior authorizations and patient drug program management.

Qualifications:

• Minimum 2 years of experience in an ambulatory clinic setting.
• Knowledge of insurance plans, medication formularies, and the prior authorization process.
• Strong organizational and multitasking skills, with the ability to manage multiple requests simultaneously.
• Excellent communication skills, both verbal and written, for interactions with healthcare professionals, patients, and insurance companies.
• Excellent documentation skills and follow-through ability.
• Proficiency in electronic medical records (EMR) systems and authorization software.

Preferred:

• Experience with medication prior authorizations.
• Experience in working with primary care and specialty clinics.
• Familiarity with South Central Clinics or similar healthcare environments.

The above statements describe the general nature and level of work only. They are not an exhaustive list of all required responsibilities, duties, and skills. Other duties may be added, or this description amended at any time.