What are the responsibilities and job description for the Prior Authorization Specialist position at SPCP/Southeast Medical Group?
Job Description
Job Description
Description :
The Prior Authorization Specialist is responsible for obtaining and managing prior authorizations for medical services, procedures, and medications as required by insurance providers. This role is vital in ensuring patients receive timely and appropriate care while adhering to insurance guidelines and requirements.
Requirements :
Key Responsibilities :
- Review and process requests for prior authorization for medical services, procedures, and medications.
- Understand the differences between Buy and Bill vs. in-house billables for medication prior authorization.
- Utilize platforms such as Cover My Meds and Transact RX for managing prior authorizations.
- Manage the MA / Provider Inbox to ensure timely responses to inquiries and requests.
- Work with care gap lists provided by insurance vendors to identify and address gaps in patient care.
- Assist in closing care gaps identified by MCAWE (Medicare Advantage With Enhanced Benefits).
- Communicate with healthcare providers, insurance companies, and patients to gather necessary information for prior authorization requests.
- Verify insurance coverage and benefits for patients and inform them of any financial responsibilities.
- Track and follow up on pending prior authorization requests to ensure timely approval.
- Maintain accurate and up-to-date records of all prior authorization activities.
- Collaborate with healthcare providers and billing departments to resolve any issues related to prior authorizations.
- Educate patients and healthcare providers about insurance requirements and prior authorization processes.
- Stay current with changes in insurance policies and guidelines related to prior authorizations.
Qualifications :
Key physical and mental requirements :
FLSA Classification : Non-exempt
Southeast Primary Care Partners is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.
12 / 2024
