Prescription Prior Authorization Representative

Description

Job Summary:

The Prescription Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations from insurance carriers by receiving prescriptions, addressing and rectifying rejected claims and conducting necessary third party authorization requests.

The Prescription Prior Authorization Specialist has direct over-the-phone interaction with patients and is an integral component in helping deliver our mission of bringing state-of-the-art expertise and patient care to our clientele.

Why Waccamaw Dermatology

If you are looking to be a part of a dynamic team who enjoys helping others and believes that quality healthcare is for everyone, bring your critical thinking skills, positive attitude, cheerful smile and join a special team that makes a true difference!

Duties/Responsibilities

• Assists with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed.
• Follows prior authorization workflow and policies and procedures.
• Collaborates with other departments to assist in obtaining prior authorizations.
• Reviews accuracy and completeness of information requested and ensure that all supporting documents are present.
• Receives requests for prior authorizations and ensure that they are properly and closely monitored.
• Consults with supervisor or pharmacist to obtain clearance that treatment regimen is appropriate.
• Processes referrals and submit clinical supporting documentation to insurance carriers to expedite prior authorization processes.
• Manages correspondence with insurance companies, physicians and patients as required.
• Reveiws denials and submit appeals if requested by physician to get them approved from insurance companies.
• Documents all prior authorization information including approval dates, prior authorization number in patient profile.
• Proactively works on prior authorizations that are due to be expired.
• Secures patients’ demographics and medical information by using great discretion and ensuring that all procedures are in sync with HIPAA compliance and regulations.
• Maintains patient confidence and protects operations by always keeping information confidential in compliance with all HIPAA and OSHA rules and regulations.
• Contributes to team effort by accomplishing all related tasks as needed.
• Always provides superior customer service excellence.
• Remains flexible on behalf of the position and the team.
• Ability to interact both positively and professionally through multiple departments within the practice.
• Ability to work both independently as well as within a team environment.
• All other duties as assigned.
  
  

Requirements

Education and Experience Requirements:

• Medical Assistant experience or the equivalent medical background in a high-volume medical setting with the ability to read, write and interpret medical terminology, dermatology a plus.
• Ability to speak other languages a plus.
  
  

Working Conditions

• Required to move from one location to another within and outside of the building; push, pull and reach; bend; sit for extended periods of time
• Ability to work 8-10 hour shifts and be available for overtime when necessary.
• Must be able to speak and write English fluently.
• Ability to lift to 25 lbs.
  
  

On-Site Presence Required at least three days per week with the option to potentially work remotely two days per week following a successful in-person training plan.

Hours: TBD based upon department needs between the hours of 7:00am-5:30pm Monday - Friday as assigned.