Prior Authorization Coordinator - Hybrid
About The Position
The Prior Authorization Coordinator is responsible for demonstrating knowledge and application of job duties within scope of practice and functions under the direction of the manager(s) and/or Director(s); respectfully interacts with all levels of staff; provides assistance, as needed, during assigned duty hours; participates in department activities; promotes independence; adherence to the attendance policy; encourages socialization; advocates for the quality of life of our patients while maintaining compliance with all applicable laws, regulatory and organizational standards; supports the company’s core values.
Requirements
- High school diploma/ GED
- Knowledge of medical terminology
- Ability to work independently
- Proficient and accurate with word processing (Word), spreadsheets (Excel), charting, flowcharting, and computers in general
- Attention to detail is essential
- Ability to perform multiple tasks simultaneously with accuracy and efficiency while maintaining composure.
- Strong written and verbal communication skills.
- Must be at least 18 years of age
- Experience obtaining prior authorization
Nice To Haves
- Previous experience with Biologics/Prior Authorizations preferred
- Previous medical office experience preferred
- EMR experience preferred
Responsibilities
- Works closely with the biologic/specialty medication specialist nurse to help streamline the process’.
- Communicates with providers, nurses, managers, and patients to track specialty medications and biologics given or received.
- Communicates on the telephone professionally and pleasantly. Efficiently screens and directs calls and make appointments as necessary for the biologics and specialty medication process, if required
- Runs reports to track appointments/biologics inventory and maintains integrity of patient charts.
- Collecting all necessary documentation to complete timely and accurate submission of prior authorizations, appeals and scheduling physician peer to peers for biologics and specialty medications, as necessary.
- Interacts with clients, insurance companies, sales representatives, providers, and patients, as necessary.
- Maintain and follow HIPAA policies and procedures.
- Monitors workflow and databases for outstanding authorization or re-authorizations to ensure timely processing of patients for services, care and billing.
- Other relevant duties as assigned by manager
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
Number of Employees
251-500 employees
