Prior Authorization Specialist - Northwest

About the role

Provides support to the family practice department by processing all medication Prior Authorization requests. Utilizes Athena and Cover My Meds Portal to process prior authorizations. Reviews medical record documentation in order to obtain medical justification for new medications and/or DME prescribed by the providers. Communicates with pharmacies and patients as needed.

Responsibilities

• Collaborates with patients, pharmacies, insurance providers, the CoverMyMeds portal, and pod staff to facilitate the processing of prior authorization requests.
• Handles the access and processing of Right Fax Prior Authorization requests.
• Handles walk-in patients’ and telephonic refill requests and provides assistance to those seeking updates on prior authorization requests.
• Collaborates with Medication Adherence Team to help improve medication adherence metrics.
• Manages Prior Authorization schedule for prior authorization or refill needs.
• Phones patients as needed regarding results, changes in medication, dosage, and other information provided by the provider.

General requirements

• All duties performed will be done accurately and in a timely manner.
• Assumes responsibility for maintaining clinical competencies according to Gonzaba Medical Group policy.
• Ensures customer service is always maintained at the highest level.
• Exercises tact and courtesy when dealing with patients, visitors, providers, and co-workers.
• Must always adhere to customer service expectations including in-person and virtual (via telephone, or telehealth applications) communication.
• Participates in educational programs as needed.
• Provides leadership, direction, and support to medical assistants’ and LVNs’ on the issues of outpatient care, medications, or scheduling.
• Assists different teams as necessary including performing the duties of other personnel as needed.
• Maintains strict confidentiality by adhering to all HIPAA rules and regulations.

Work environment

Clinic environment. Exposure to communicable diseases, bodily fluids, toxic substances, ionizing radiation, medicinal preparations, and other conditions common to a clinic environment.

Mental / Physical requirements

• Requires manual dexterity, sitting, standing, stooping, reaching, kneeling, crouching, bending, walking, lifting up to 40 lbs. without assistance.
• Close vision and ability to adjust focus.
• Must be able to work efficiently under pressure.