[Hiring] Prior Authorization Coordinator @APDerm

Role Description

Under the general supervision of the Clinical Call Center Manager, the Prior Authorization Coordinator will be responsible for medication and procedure Prior Authorization process including Prescription Refills.

• Interview patients to determine how they can be assisted in receiving authorizations for their medication and procedures.
• Process necessary documentation to expedite approvals and ensure that appropriate follow-up is performed.
• Receive requests for pre-authorizations and ensure that they are properly and closely monitored.
• Obtain authorization from insurances requiring authorization via telephone, facsimile, or online systems while maintaining compliance to medical record confidentiality regulations.
• Review accuracy and completeness of information requested and ensure that all supporting documents are present.
• Process referrals and submit medical records to insurance carriers to expedite prior authorization processes.
• Manage correspondence with insurance companies, physicians, specialists, and patients as required.
• Manage denials and submit appeals to get them approved from insurance companies.
• Create accurate and consistent documentation in patient’s records to ensure that pre-authorization information is properly updated. Record all prior authorizations phone calls, documents, and authorization numbers in Centricity.

Qualifications

• High School diploma/ GED required.
• Current Certified Medical Assistant certificate preferred.
• Certified and licensed pharmacy technician preferred.

Requirements

• Knowledge of online authorization systems and status review.
• Must possess excellent computer skills to input and retrieve clinical information.
• Ability to track in-process authorizations from multiple sources.
• Knowledge of medical terminology.
• Works efficiently with minimal supervision, exercising independent judgment within stated guidelines.
• Demonstrates effective interpersonal skills which promote cooperation and teamwork.
• Strong Customer Service skills required to communicate with patients, family members, physicians, and other health care providers, as well as insurance companies and team members in a positive and professional manner.
• Ability to withstand varying job pressures, organize/prioritize related job tasks, and excellent attention to detail.
• Excellent public relations skills and demonstrated ability to communicate in calm, businesslike manner.
• Ability to multitask, learn new skills and adapt to change.
• Maintains a ONETeam mindset using the foundation of our core values, the 3Ps: Positivity, Productivity, and Professionalism.
• Support APDerm’s mission and culture of high-quality standards by carrying out applicable policies, procedures and established industry standards, laws and regulations.
• Complete all assigned required training by the deadline including, but not limited to the Code of Conduct, Privacy & Data Security, and OSHA.

Benefits

• Medical plans with HMO or PPO options.
• Dental plan.
• Healthcare Savings Account (HSA).
• 401k plan with generous match.
• Employee Assistance Plan.
• Additional benefit options such as short-term disability, accident, cancer indemnity, and life insurance through AFLAC.