Centralized Medication Prior Authorization Specialist (CMA or LPN)
US-IA-Fort Dodge
careers
Req #: 180505
Type: Full Time Benefits
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Overview: Medication Prior Authorization Specialist Full-time postion with benefits (40 hours per week) Daytime hours The Medication Prior Authorization Specialist (Clinical) is responsible for obtaining timely prior authorizations for medications to ensure uninterrupted patient care. This role supports physicians, providers, and clinical team members in the Quad Cities by navigating insurance requirements and improving patient access to necessary medications. Responsibilities: * Coordinate and process prior authorization requests for prescription medications and injections. * Review clinical documentation to ensure completeness and compliance with payer requirements. * Track and follow up on pending authorizations, ensuring timely approvals or appeals. * Assist with appeals and denials, including gathering supporting documentation. * Document all authorization activities within the Electronic Medical Record. * Educate other team members in the clinic on payer-specific requirements and changes in authorization policies. * Maintain up to date knowledge of insurance plans, formularies, and coverage criteria. * Monitor and report on authorization trends and denials to support process improvement initiatives. * Collaborate with clinical teams to ensure timely submission of accurate and complete prior authorization requests, minimizing delays in care. * Conduct work as an extension of the clinical care team in support of excellent experience. * Contribute to the development and maintenance of standard operating procedures related to prior authorization workflows * Establish effective mechanisms of communication with staff, physicians, advanced practice practitioners, and patients. * Act as a liaison between providers, patients, insurance companies, and leadership in the realm of prior authorization expertise * Monitoring of clinical outcomes and patient satisfaction to ensure highest level of care delivery. * Collaborating with interdisciplinary teams to coordinate comprehensive care and continuously seek to improve the process or need for prior authorization. Qualifications: Education: Graduate of an accredited program for Medical Assistants. 3-5 years of experience as a Certified Medical Assistant will be considered as an alternative requirement if a graduate from a non-accredited program. Being a graduate of a registered Apprenticeship will also be considered as alternative minimum requirements. License(s)/Certification(s): Current CMA certification for Certified Medical Assistant from AAMA, NCCT, AMT, or NHS
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