Prior Authorization Job Purpose: Assists patients in prior authorization process, including reviewing of medications and imaging orders. Helps patients by providing information, services, and assistance.

DUTIES INCLUDE, BUT ARE NOT LIMITED TO THE FOLLOWING

· Receives new medication and medication refill requests for authorization review.

· Obtains verbal authorizations and requests detailed clinical information from prescribers.

· Approves coverage determination requests based on defined criteria within the scope of approved protocols

· Contacts insurance companies to obtain prior authorization on medications and documents coverage determination in patient’s electronic medical record.

· Obtains prior authorization on imaging orders.

· Monitors and responds to electronic refill requests and ensures each refill is documented in the patient’s chart.

· Communicate pertinent information to prescribing provider and/or pharmacy.

· Secures patient information and maintains patient confidence by completing and safeguarding medical records.

· Completes diagnostic and procedure coding as required/needed.

· Counsels patients by transmitting physician's orders and questions about medication.

· Maintains safe, secure, and healthy work environment by establishing and following standards and procedures; complying with legal regulations.

· Familiar with standard concepts, practices, and procedures within the medical field including basic medical terminology.

· Practices safe habits including but not limited to infection control, lifting procedures, etc.)

· Presents a professional image and customer focus.

· Practices teamwork by helping others willingly and communicating in a professional manner

· Keeps equipment operating by following operating instructions; troubleshooting breakdowns; maintaining supplies; performing preventive maintenance; calling for repairs.

· Updates job knowledge by participating in educational opportunities; reading professional publications.

· Serves and protects the practice by adhering to professional standards, policies and procedures, federal, state, and local requirements.

· Operates standard office equipment (e.g. copier, personal computer, fax, etc.).

· Has regular and predictable attendance

· Adheres to Advanced Pain Care’s Policies and procedures

· Performs other duties as assigned.

SUPERVISION Reports to Location Manager

MINIMUM QUALIFICATIIONS

Education: Requires a high school diploma or GED, and certified medical assistant certificate

Experience: None required, but two or more years preferred

WORKING CONDITIONS

Environmental Conditions: Medical Office environment

Physical Conditions:

· Must be able to work as scheduled – typically from 8:00 – 5:00 M-F

· Must be able to sit and/or stand for prolonged periods of time

· Must be able to bend, stoop and stretch

· Must be able to lift and move boxes and other items weighing up to 30 pounds.

· Requires eye-hand coordination and manual dexterity sufficient to operate office equipment, etc.

KNOWLEDGE AND SKILLS

· Clear and precise communication

· Knowledge of medical terminology

· Effectively manages day by organizing and prioritizing

· Applies tactful principles and practices of dealing with the public

· Practices safety

· Protects patient information and maintains confidentiality