Clinical Prior-Authorization Specialist - CMA

Advanced Pain Care•Austin, TX

8d•$18 - $22

About The Position

The Clinical Prior-Authorization Specialist assists patients with the prior authorization process for medications and imaging orders. The role reviews authorization requests, obtains clinical information from prescribers, secures coverage determinations within approved protocols, and documents decisions in patient records. The specialist also responds to refill requests, communicates with prescribing providers and pharmacies, provides patients with information about medication orders, and completes diagnostic and procedure coding as needed. The position requires maintaining secure, accurate medical records and protecting patient confidentiality. The specialist follows workplace safety and infection-control practices, maintains a professional and patient-focused approach, supports teamwork, operates standard office equipment, and adheres to practice policies and applicable requirements. Regular and predictable attendance is required; other duties may be assigned.

Requirements

High school diploma or GED.
Certified Medical Assistant required.
Clear and precise communication skills.
Knowledge of medical terminology.
Ability to organize and prioritize work.
Ability to deal tactfully with the public.
Ability to follow safety practices and protect patient information and confidentiality.

Nice To Haves

One or more years of experience preferred.

Responsibilities

Receive new medication and medication refill requests for authorization review.
Obtain verbal authorizations and request detailed clinical information from prescribers.
Approve coverage determination requests based on defined criteria within approved protocols.
Contact insurance companies to obtain prior authorization for medications and document coverage determinations in the patient’s electronic medical record.
Obtain prior authorization for imaging orders.
Monitor and respond to electronic refill requests and ensure each refill is documented in the patient’s chart.
Communicate pertinent information to prescribing providers and/or pharmacies.
Secure patient information and maintain patient confidence by completing and safeguarding medical records.
Complete diagnostic and procedure coding as required or needed.
Counsel patients by transmitting physician orders and answering questions about medication.
Maintain a safe, secure, and healthy work environment by following standards, procedures, and legal requirements.
Practice safe habits, including infection control and proper lifting procedures.
Present a professional image and maintain a customer-focused approach.
Support teamwork by helping others willingly and communicating professionally.
Maintain equipment by following operating instructions, troubleshooting breakdowns, maintaining supplies, performing preventive maintenance, and calling for repairs.
Update job knowledge by participating in educational opportunities and reading professional publications.
Adhere to professional standards, practice policies and procedures, and federal, state, and local requirements.
Operate standard office equipment, including a copier, personal computer, and fax machine.
Maintain regular and predictable attendance and adhere to Advanced Pain Care’s policies and procedures.
Perform other duties as assigned.