Medication Authorization Specialist

Default Work Shift:

Day (United States of America)

Hours:

40

Salary range:

$19.72 - $29.95

Schedule:

Full Time

Shift Hours:

8 Hour employee

Department:

Administration (ELCCC)

Job Objective:

Under the supervision of the Business Office Manager, submits requests for medication authorization to insurance companies and provides documentation to support complex infusion treatments.

Job Description:

Education: Required: High school diploma, GED or higher level degree Licensure/Certification: N/A Experience: Preferred: Experience reviewing medication authorizations in a medical office; experience working with EMR systems; experience in oncology

Reports To: Business Office Manager, Multiple Service Lines Supervises: N/A Ages of Patients: Adult, Geriatric Blood Borne Pathogens: Minimal/ No Potential

Skills, Knowledge, Abilities:

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

Essential Responsibilities

1. Demonstrates compliance with Code of Conduct and compliance policies, and takes action to resolve compliance questions or concerns and report suspected violations. 2. Ensures the accurate and timely processing of injection and infusion orders. 3. Works with third-party insurance representatives and EMC clinical staff to process prior authorization requests for infusions and injections. 4. 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. 5. Reviews authorization queue for orders and makes sure the schedule is clear for the coming days. 6. Observes payor contractual authorization requirements. 7. Utilizes website portals and electronic options (when available) to submit authorization requests. Employs other communication sources when required by the payor. 8. Works with management to identify payor trends, preferred medications, biosimilars and/or generics. 9. Performs other duties as assigned.