Prior Authorization Specialist - Northwest

Gonzaba Medical Group • San Antonio, TX

10d • Onsite

About The Position

Provides support to the family practice department by processing all medication Prior Authorization requests. Utilizes Athena and Cover My Med Portal to process prior authorizations. Reviews medical record documentation in order to obtain medical justification for new medications and or DME prescribed by the providers. Communicates with pharmacies and patients as needed. Gonzaba Medical Group is seeking team members who contribute as A-Players, demonstrate a strong work ethic, are committed to the culture and our core values.

Requirements

• Minimum high school education or equivalent.
• Must hold a certificate from an accredited medical assistant school or possess equivalent medical training.
• CPR certification with AED is required and must be kept current.
• National certification as a Registered or Certified Medical Assistant is required.
• Skilled in use of computer/EMR systems.
• Knowledge of Word processing software, spreadsheet software, Internet, and database software.
• All duties performed will be done accurately and in a timely manner.

Nice To Haves

• Minimum of one-year experience in a clinic, doctor’s office or hospital is preferred.
• National Certification must be issued from one of the following associations: AAMA - Certified Medical Assistant (CMA); ARMA - Registered Medical Assistant (RMA); NAHP - Nationally Registered Certified Medical Assistant (NRCMA); or other association approved by GMG Human Resources.

Responsibilities

• Processes all medication Prior Authorization requests.
• Utilizes Athena and Cover My Med Portal to process prior authorizations.
• Reviews medical record documentation to obtain medical justification for new medications and/or DME prescribed by providers.
• Communicates with pharmacies and patients as needed.
• Collaborates with patients, pharmacies, insurance providers, the CoverMyMeds portal, and pod staff to facilitate the processing of prior authorization requests.
• Handles the access and processing of Right Fax Prior Authorization requests.
• Handles walk-in patients' and telephonic refill requests and provides assistance to those seeking updates on prior authorization requests.
• Collaborates with Medication Adherence Team to help improve medication adherence metrics.
• Manages Prior Authorization schedule for prior authorization or refill needs.
• Phones patients as needed regarding results, changes in medication, dosage, and other information provided by the provider.
• Assumes responsibility for maintaining clinical competencies according to Gonzaba Medical Group policy.
• Ensures customer service is always maintained at the highest level.
• Exercises tact and courtesy when dealing with patients, visitors, providers, and co-workers.
• Adheres to customer service expectations including in-person and virtual (via telephone, or telehealth applications) communication.
• Participates in educational programs as needed.
• Provides leadership, direction, and support to medical assistants’ and LVNs’ on the issues of outpatient care, medications, or scheduling.
• Assists different teams as necessary including performing the duties of other personnel as needed.
• Maintains strict confidentiality by adhering to all HIPAA rules and regulations.

What This Job Offers

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