Medication Authorization Specialist

Requirements

• Preferred: Experience reviewing medication authorizations in a medical office; experience working with EMR systems; experience in oncology
• Reports To: Business Office Manager, Multiple Service Lines
• Supervises: N/A
• Ages of Patients: Adult, Geriatric
• Blood Borne Pathogens: Minimal/ No Potential
• Skills, Knowledge, Abilities:
• Ability to effectively communicate and write clearly, Exceptional customer service skills, Insurance knowledge, both government and commercial, Self-starter; driven to take action without needing prompting, Strong computer skills
• Essential Responsibilities
• Demonstrates compliance with Code of Conduct and compliance policies, and takes action to resolve compliance questions or concerns and report suspected violations.
• Ensures the accurate and timely processing of injection and infusion orders.
• Works with third-party insurance representatives and EMC clinical staff to process prior authorization requests for infusions and injections.
• Obtains required clinical documentation for prior authorization (ex: progress notes, labs, diagnoses codes, previous therapies, etc.), ensuring all needed clinical records are collected in order to have treatment authorized on the first attempt.
• Reviews authorization queue for orders and makes sure the schedule is clear for the coming days.
• Observes payor contractual authorization requirements.
• Utilizes website portals and electronic options (when available) to submit authorization requests. Employs other communication sources when required by the payor.
• Works with management to identify payor trends, preferred medications, biosimilars and/or generics.
• Performs other duties as assigned.

Benefits

Additional Information

Default Work Shift: Day (United States of America) Hours: 40 Salary range: $19.72 - $29.95 Schedule: Full Time Shift Hours: 8 Hour employee Department: Administration (ELCCC) Job Objective: Under the supervision of the Business Office Manager, submits requests for medication authorization to insurance companies and provides documentation to support complex infusion treatments. Job Description: Education: Required: High school diploma, GED or higher level degree Licensure/Certification: N/A

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