Prior Authorization Specialist - Clinical​/Office

Overview

Summary/Objective
Effectively obtain insurance authorizations for patients prescribed medication

Description
Summary/Objective:
Effectively obtain insurance authorizations for patients prescribed medication

• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Responsible for authorizations in multi-provider practice.
• Obtain patient insurance information and contact insurance carriers online or by phone to verify requirements.
• Research clinical information from medical record needed to obtain prior authorizations from insurance companies or patient assistance programs.
• Communicating authorizations to patients and physicians explaining approvals or denials for medication when needed.
• Field any phone calls and emails related to authorizations.
• Establish relationships with drug companies.

• Excellent organizational and problem-solving skills
• Demonstrates well developed interpersonal/communication skills necessary to interact effectively with internal and external customers
• Ability to evaluate a variety of patient situations and make timely decisions
• Must demonstrate ability to work in fast-paced, deadline-oriented environment, with minimal supervision, with the ability to meet deadlines is a must with constant communication required
• Strong computer skills, including basic keyboarding, experience with Microsoft Office software (Outlook, Work, Excel)
• Ability to support and understand authorization processes
• Knowledge and/or willingness to understand insurance guidelines and requirements to successfully complete prior authorizations/pre-determinations

None

This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.

The employee is occasionally required to stand; walk; sit; and reach with hands and arms. Repetitive hand movement due to extended computer use. The employee must occasionally lift and/or move up to 25 pounds.

Full Time / Monday – Friday

None

Must be authorized to work in the US for any employer

US Digestive Health is an Equal Opportunity Employer. USDH does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, non-disqualifying physical or mental disability, national origin, veteran status or any other basis covered by appropriate law. All employment is decided based on qualifications, merit, and business need

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

• High School Diploma or GED equivalent
• Minimum 3-5 years of experience in customer service preferred but not required.
• Prefer previous Medication Authorization responsibilities
• Allscripts EMR program a plus