Prior Auth Specialist Medications

Job Description

Duties and Responsibilities

Primary Job Functions:

Responsible for reviewing, submitting, monitoring, and responding to issues regarding medication prior authorizations.

Reviews patient medical history to identify supporting documentation in the patient chart relevant to the medication.

Professionally communicates with prescribers, practice support staff, patients, and representatives of insurance companies; includes oral and written communication.

Responsible for contacting insurance companies via appropriate method to obtain prior authorization.

Updates information in the patient medical record with approval or declination information; follows up with ordering physician as to status of prior authorization.

Efficiently tracks pending authorizations for multiple offices/prescribers.

Creates a positive, professional, service-oriented work environment for staff, patients, and family members by supporting the mission and values of OGG.

Secondary Job Functions:

Attends required meetings and training as requested.

Maintain confidentiality of patient and financial information by utilizing HIPPA guidelines and regulations.

Adheres to all Federal, State, and Local laws and regulations as well as policies set forth by Ohio Gastroenterology Group Inc, and its related parties.

Knowledge, Skills, and Abilities

Knowledge of third-party payers and prior authorization requirements

Understanding of basic medical terminology and medications

Proficient use of office equipment, such as copier, fax machine, phones, etc.

Intermediate computer skills including use of Microsoft Office (Excel and Word), electronic mail, payer websites, physician practice management, and electronic medical record systems.

Strong time management skills

Ability to work independently with minimal supervision and to manage multiple priorities.

Strong written and verbal communication skills

Ability to effectively communicate with a variety of individuals.

Neat appearance, professional demeanor, and pleasant voice

Fluent in English

Credentials and Experience

Must have a high school diploma or equivalent.

One (1) year of experience and relevant knowledge of insurance eligibility or prior authorization in a healthcare setting preferred.

Certified pharmacy technician, certified medical assistant, or licensed practical nurse preferred.

Work Environment

Minimal medical office exposure that may require contact with adult patients

Office workstation environment with numerous employees

Ohio Gastroenterology Group offers a nice life/work balance and a great benefits package that includes:

Medical, dental and vision coverage- benefits are effective the first of the month following 30 days of employment

Company paid life insurance and short term disability

Generous paid time off plans (vacation, sick and personal)

7 paid holidays

Two retirements plans:

401(k) plan that offers a 3% safe harbor contribution with immediate vesting as well as annual profit sharing contributions.

Cash balance pension plan – company contributes 2.5% and offers full vesting after 3 years of employment.

Tuition reimbursement programs

Employee appreciation programs

Uniform reimbursement programs

Growth opportunities

Learning and development training

Full-time