Clinical Prior-Authorization Specialist - CMA

Advanced Pain Care•Austin, TX

About The Position

The Clinical Prior-Authorization Specialist assists patients with the prior-authorization process for medications and imaging orders, providing information, services, and support. The role reviews medication and refill requests, obtains authorizations and clinical information, processes coverage determinations according to approved protocols, and documents decisions in patients’ electronic medical records. The specialist also communicates relevant information to providers and pharmacies, protects confidential patient information, supports safe and professional clinic operations, and performs other duties as assigned.

Requirements

High school diploma or GED.
Certified Medical Assistant credential required.
Clear and precise communication skills.
Knowledge of medical terminology.
Ability to organize and prioritize work effectively.
Tactful public-facing communication skills.
Ability to practice safety, protect patient information, and maintain 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 medication prior authorizations 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 pharmacies.
Safeguard medical records and maintain patient confidentiality.
Complete diagnostic and procedure coding as required.
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 regulations.
Follow safe practices, including infection control and lifting procedures.
Present a professional image and maintain a customer focus.
Work cooperatively and communicate professionally with others.
Maintain equipment and supplies, troubleshoot breakdowns, perform preventive maintenance, and arrange repairs as needed.
Maintain job knowledge through educational opportunities and professional publications.
Follow professional standards, practice policies and procedures, and applicable federal, state, and local requirements.
Operate standard office equipment, including copiers, personal computers, and fax machines.
Maintain regular and predictable attendance and adhere to Advanced Pain Care policies and procedures.
Perform other duties as assigned.