Biologics Coordinator/Medication Prior Author

CLEAVER MEDICAL GROUP PC•Dahlonega, GA

8d•$17 - $24•Onsite

About The Position

Cleaver Dermatology & Aesthetics is seeking a detail-oriented and organized Biologics & Medication Prior Authorization Specialist to join our Dermatology team! This position is responsible for managing the prior authorization process for dermatology medications, including biologics and specialty medications. The ideal candidate is highly organized, comfortable working with insurance companies, and able to effectively communicate with patients, pharmacies, providers, and insurance representatives. This is an important role within our practice and requires someone who can take ownership of the authorization process from start to finish, follow up consistently, and ensure patients receive their medications as efficiently as possible.

Requirements

Previous experience with prior authorizations, medication authorizations, specialty medications, or insurance verification preferred
Dermatology experience is a plus
Experience working with biologics is highly preferred
Strong understanding of health insurance processes and terminology
Comfortable navigating insurance and pharmacy benefit websites and portals
Excellent organizational and time-management skills
Strong attention to detail and accuracy
Excellent written and verbal communication skills
Ability to effectively communicate with insurance companies, pharmacies, providers, and patients
Ability to manage multiple authorizations and deadlines simultaneously
Comfortable working independently while also collaborating with a clinical team
Strong problem-solving and follow-up skills
Experience with electronic medical records (EMR) preferred
Must be dependable, professional, and able to maintain patient confidentiality

Nice To Haves

Prior experience with dermatology biologics and medication prior authorizations is highly valued, but we are willing to train the right candidate who has strong medical office, insurance, or clinical experience.

Responsibilities

Manage prior authorizations for dermatology medications, including biologics, specialty medications, and other prescription therapies
Submit and process medication prior authorizations through insurance portals, electronic systems, and other required platforms
Review insurance requirements and determine necessary documentation for medication approvals
Gather supporting clinical documentation, including office notes, diagnosis information, previous treatments, medication history, and treatment failures
Communicate with providers and clinical staff regarding prior authorization requirements and necessary documentation
Communicate with insurance companies and pharmacy benefit managers regarding authorization status and requirements
Track pending, approved, denied, and appealed prior authorizations
Follow up regularly on outstanding authorizations to prevent unnecessary delays in patient care
Process medication-related paperwork and maintain accurate documentation in the patient's medical record
Assist with appeals and requests for reconsideration when medications are denied
Coordinate with specialty pharmacies and medication manufacturers as needed
Assist patients with questions regarding medication approvals, pharmacy coordination, and next steps
Help patients navigate insurance-related barriers to obtaining prescribed medications
Monitor authorization expiration dates and assist with renewals when necessary
Maintain accurate records and ensure all authorization activity is documented appropriately
Work closely with providers, clinical staff, pharmacies, and insurance companies to resolve medication access issues
Protect patient privacy and maintain HIPAA compliance at all times
Perform other administrative and clinical support duties as needed