POSITION SUMMARY
The Medication Prior Authorization Specialist is responsible for ensuring that medication prior authorization are submitted to payers once orders are received from providers to ensure that patients will be able to obtain the medication in a timely manner. The Medication Prior Authorization Specialist contacts payers to request service authorization and may collect financial and/or demographic information from patients as needed.
POSITION QUALIFICATIONS
Education and Experience:
LPN or CMA with experience in Medication Prior Authorization. Must have excellent customer service and communication skills.
License/Certificates:
Current LPN license for State of Minnesota. CMA certification/registration. American Heart Association BLS certification required within 30 days of hire.
Special Skills and Aptitudes:
Familiarity with medical terminology and healthcare insurance processes.
Ability to work independently with strong attention to detail.
Ability to prioritize and multitask.
Ability to perform routine and complex procedures.
Ability to recognize problems, identify the cause and implement solution.
Ability to deal with others in a courteous and tactful manner.
Knowledge of EMR systems.
ESSENTIAL RESPONSIBILITIES
Verify patients' insurance, benefit and clinical information.
Obtain medication prior authorization from third-party payers in accordance with payer requirements.
Contact patients to gather demographic and insurance information as needed, and updates patient information within the EMR as necessary.
Work with other departments to gather the clinical information required by the payer to authorize services.
Document prior authorization in EMR and send paperwork for scanning to maintain accurate records of authorizations within the EMR.
Identify patients who will need to receive Medicare Advantage Beneficiary Notices of Non-coverages (ABNs).
Communicate with scheduling staff and/or clinical areas after prior authorization is obtained when needed.
Work with patients if authorization is not obtained.
Comply with HIPAA regulations, as well as the organization's policies and procedures regarding patient privacy and confidentiality.
Maintain professional tone at all times when communicating with patients, payers representatives and physicians.
Demonstrate Standards of Excellence when other duties are assigned