Medication Authorization Specialist

Eisenhower Health • Rancho Mirage, CA

5d • Onsite

About The Position

Under the supervision of the Business Office Manager, submits requests for medication authorization to insurance companies and provides documentation to support complex infusion treatments. Eisenhower has been a leader in health care for the Coachella Valley since we opened our medical center in 1971. Since then, we’ve been growing steadily, adding services, capabilities and facilities to anticipate and meet the needs of our expanding area. Today, the Eisenhower name extends far beyond the state-of-the-art care we deliver at the hospital.

Requirements

• High school diploma, GED or higher level degree
• 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

Nice To Haves

• Experience reviewing medication authorizations in a medical office
• Experience working with EMR systems
• Experience in oncology

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED