Prior Authorization Specialist - Continuum of Care - Full Time Day Shift (25383)

Requirements

• Complete medication and procedural prior authorizations through CoverMyMeds, payer portals such as Availity or Navinet, phone calls, and OTHER electronic systems.
• Communicate with insurance companies to clarify coverage requirements, criteria, and documentation needs.
• Collaborate with providers to gather and review clinical documentation for medical necessity and collect additional information required to obtain authorization.
• Communicate with patients regarding prior authorization updates, medication issues, or required documentation as needed.
• Track, follow up, and document all authorization statuses to ensure timely patient access to care.
• Assist providers and nurses with prior authorization related questions.
• Review denials, initiate appeals and submit supporting clinical notes to reverse decision as applicable.
• Maintain confidentiality and compliance with HIPAA and clinic policies.
• Other responsibilities as assigned that’s related to the department’s functions.

Benefits

• Comprehensive benefits package
• Competitive medical, dental, and vision plans
• Generous time off policy
• Nine paid holidays
• Robust tuition reimbursement
• Continuing education programs