Medication Authorization Specialist

Overview Ensures efficient initiation and follow-up of prior authorizations for various medications. Coordinates with clinic staff, insurance carriers, patients, pharmacy, and providers to accurately complete required documentation for insurance verification and approval in a timely manner.

Responsibilities Must be highly motivated and able to work independently with minimal direct supervision Able to communicate effectively with pharmacists, nurses, and other healthcare workers in a mature, approachable, professional, and comfortable manner both in-person and on the phone Excellent organizational and time management skills to prioritize multiple tasks efficiently Strong attention to detail Able to learn required computer skills Able to train other personnel Initiate, review, and process prior authorization requests and reapprovals for medications Verify insurance coverage and eligibility for requested medications Request and collect necessary documentation from healthcare provider offices, ensuring all required information is complete and accurate for prior authorization submissions Communicate with healthcare providers, insurance companies, and patients regarding authorization status and requirements Monitor the progress of prior authorizations and diligently follow up with insurance providers and healthcare professionals to expedite approval processes Maintain professional and effective communication with healthcare provider offices to obtain additional information, clarify details, and ensure a smooth prior authorization process Provide exceptional customer service to patients, healthcare providers, and internal team members, addressing inquiries and concerns promptly and courteously Assist in initiating appeals when necessary and follow up on appeals to ensure timely resolution Demonstrate the ability to multitask efficiently in a fast-paced environment, managing multiple prior authorizations simultaneously Maintain confidentiality and adhere to HIPAA regulations when handling sensitive patient information Clearly document progress on each prior authorization and all communications and contacts with providers and personnel Assists in performance improvement activities Shares in the responsibility for maintaining order and cleanliness of the department Maintains a level of productivity suitable for the department Other duties as assigned Qualifications High school diploma or equivalent required.

Previous experience in medical billing or prior authorization is highly preferred.Must be highly motivated and able to work independently with minimal direct supervision Able to communicate effectively with pharmacists, nurses, and other healthcare workers in a mature, approachable, professional, and comfortable manner both in-person and on the phone Excellent organizational and time management skills to prioritize multiple tasks efficiently Strong attention to detail Able to learn required computer skills Able to train other personnel Initiate, review, and process prior authorization requests and reapprovals for medications Verify insurance coverage and eligibility for requested medications Request and collect necessary documentation from healthcare provider offices, ensuring all required information is complete and accurate for prior authorization submissions Communicate with healthcare providers, insurance companies, and patients regarding authorization status and requirements Monitor the progress of prior authorizations and diligently follow up with insurance providers and healthcare professionals to expedite approval processes Maintain professional and effective communication with healthcare provider offices to obtain additional information, clarify details, and ensure a smooth prior authorization process Provide exceptional customer service to patients, healthcare providers, and internal team members, addressing inquiries and concerns promptly and courteously Assist in initiating appeals when necessary and follow up on appeals to ensure timely resolution Demonstrate the ability to multitask efficiently in a fast-paced environment, managing multiple prior authorizations simultaneously Maintain confidentiality and adhere to HIPAA regulations when handling sensitive patient information Clearly document progress on each prior authorization and all communications and contacts with providers and personnel Assists in performance improvement activities Shares in the responsibility for maintaining order and cleanliness of the department Maintains a level of productivity suitable for the department Other duties as assignedHigh school diploma or equivalent required.

Previous experience in medical billing or prior authorization is highly preferred.