Prior Authorization Specialist

Job Overview:
We are seeking a dedicated and detail-oriented Medication Prior Authorization Specialist to join our team at [Primary Care Office Name]. The ideal candidate will be responsible for managing and processing prior authorization requests for medications, ensuring patients receive the necessary prescriptions in a timely and efficient manner. The Medication Prior Authorization Specialist will collaborate with physicians, insurance providers, pharmacies, and patients to ensure that the prior authorization process is followed accurately and in compliance with all insurance requirements.

Key Responsibilities:

• Prior Authorization Processing: Review and process medication prior authorization requests from physicians to ensure they meet insurance requirements.
• Communication with Insurance Providers: Work closely with insurance companies to submit and follow up on prior authorization requests. Address any issues or delays to ensure prompt approval or denial decisions.
• Collaboration with Providers and Pharmacies: Communicate with prescribing physicians and pharmacy staff to gather necessary documentation, clinical information, or any additional information required to support prior authorization requests.
• Documentation Management: Maintain accurate and up-to-date records of all prior authorization submissions, approvals, and denials. Ensure proper documentation for compliance with healthcare regulations.
• Patient Interaction: Respond to patient inquiries related to prior authorization status and provide guidance on how to proceed with medication access.
• Appeals Process: When necessary, assist with the appeals process for denied medications by compiling clinical documentation and providing supporting information to insurance companies.
• Compliance & Knowledge: Stay informed of current regulations, insurance plan policies, and procedures related to medication prior authorizations. Ensure compliance with all HIPAA regulations and office protocols.
• Problem Resolution: Address any issues or concerns related to medication prior authorizations and ensure timely resolution to avoid delays in patient care.

Qualifications:

• High school diploma or equivalent; associate degree or relevant certification is a plus.
• Minimum of 1-2 years of experience in a prior authorization or insurance-related role, preferably in a healthcare setting.
• Knowledge of insurance processes, particularly in medication prior authorization requirements.
• Familiarity with medication terminology, formulary lists, and pharmaceutical processes.
• Strong communication skills and the ability to interact professionally with insurance representatives, healthcare providers, and patients.
• Detail-oriented with strong organizational skills and the ability to handle multiple tasks simultaneously.
• Ability to work independently and as part of a team in a fast-paced environment.
• Proficient in Microsoft Office Suite (Word, Excel, Outlook); experience with electronic health records (EHR) and insurance portals is a plus.

Preferred Skills:

• Previous experience working with prior authorization software or systems.
• Knowledge of healthcare industry regulations, including HIPAA.

Physical Demands:

• Ability to sit for extended periods while working on a computer.

Work Environment:

• Primary Care office, professional and collaborative work environment.
• Possibility of remote/hybrid available for the right candidate

Job Type: Full-time

Pay: From $20.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Work Location: Hybrid remote in Derry, NH 03038

Salary : $20