Waccamaw Dermatology
Prescription Prior Authorization Representative
Waccamaw Dermatology - Myrtle Beach, South Carolina, United States, 29588
Work at Waccamaw Dermatology
Overview
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Overview
Description
Job Summary:
The Prescription Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations from insurance carriers by receiving prescriptions, addressing and rectifying rejected claims and conducting necessary third party authorization requests.
The Prescription Prior Authorization Specialist has direct over-the-phone interaction with patients and is an integral component in helping deliver our mission of bringing state-of-the-art expertise and patient care to our clientele.
Why Waccamaw Dermatology:
If you are looking to be a part of a dynamic team who enjoys helping others and believes that quality healthcare is for everyone, bring your critical thinking skills, positive attitude, cheerful smile and join a special team that makes a true difference!
Duties/Responsibilities:
Assists with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed. Follows prior authorization workflow and policies and procedures. Collaborates with other departments to assist in obtaining prior authorizations. Reviews accuracy and completeness of information requested and ensure that all supporting documents are present. Receives requests for prior authorizations and ensure that they are properly and closely monitored. Consults with supervisor or pharmacist to obtain clearance that treatment regimen is appropriate. Processes referrals and submit clinical supporting documentation to insurance carriers to expedite prior authorization processes. Manages correspondence with insurance companies, physicians and patients as required. Reveiws denials and submit appeals if requested by physician to get them approved from insurance companies. Documents all prior authorization information including approval dates, prior authorization number in patient profile. Proactively works on prior authorizations that are due to be expired. Secures patients' demographics and medical information by using great discretion and ensuring that all procedures are in sync with HIPAA compliance and regulations. Maintains patient confidence and protects operations by always keeping information confidential in compliance with all HIPAA and OSHA rules and regulations. Contributes to team effort by accomplishing all related tasks as needed. Always provides superior customer service excellence. Remains flexible on behalf of the position and the team. Ability to interact both positively and professionally through multiple departments within the practice. Ability to work both independently as well as within a team environment. All other duties as assigned. Requirements
Education and Experience Requirements:
Medical Assistant experience or the equivalent medical background in a high-volume medical setting with the ability to read, write and interpret medical terminology, dermatology a plus. Ability to speak other languages a plus. Working Conditions
Required to move from one location to another within and outside of the building; push, pull and reach; bend; sit for extended periods of time Ability to work 8-10+ hour shifts and be available for overtime when necessary. Must be able to speak and write English fluently. Ability to lift to 25 lbs.
On-Site Presence Required at least three days per week with the option to potentially work remotely two days per week following a successful in-person training plan.
Hours: TBD based upon department needs between the hours of 7:00am-5:30pm Monday - Friday as assigned.
Job Summary:
The Prescription Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations from insurance carriers by receiving prescriptions, addressing and rectifying rejected claims and conducting necessary third party authorization requests.
The Prescription Prior Authorization Specialist has direct over-the-phone interaction with patients and is an integral component in helping deliver our mission of bringing state-of-the-art expertise and patient care to our clientele.
Why Waccamaw Dermatology:
If you are looking to be a part of a dynamic team who enjoys helping others and believes that quality healthcare is for everyone, bring your critical thinking skills, positive attitude, cheerful smile and join a special team that makes a true difference!
Duties/Responsibilities:
Assists with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed. Follows prior authorization workflow and policies and procedures. Collaborates with other departments to assist in obtaining prior authorizations. Reviews accuracy and completeness of information requested and ensure that all supporting documents are present. Receives requests for prior authorizations and ensure that they are properly and closely monitored. Consults with supervisor or pharmacist to obtain clearance that treatment regimen is appropriate. Processes referrals and submit clinical supporting documentation to insurance carriers to expedite prior authorization processes. Manages correspondence with insurance companies, physicians and patients as required. Reveiws denials and submit appeals if requested by physician to get them approved from insurance companies. Documents all prior authorization information including approval dates, prior authorization number in patient profile. Proactively works on prior authorizations that are due to be expired. Secures patients' demographics and medical information by using great discretion and ensuring that all procedures are in sync with HIPAA compliance and regulations. Maintains patient confidence and protects operations by always keeping information confidential in compliance with all HIPAA and OSHA rules and regulations. Contributes to team effort by accomplishing all related tasks as needed. Always provides superior customer service excellence. Remains flexible on behalf of the position and the team. Ability to interact both positively and professionally through multiple departments within the practice. Ability to work both independently as well as within a team environment. All other duties as assigned. Requirements
Education and Experience Requirements:
Medical Assistant experience or the equivalent medical background in a high-volume medical setting with the ability to read, write and interpret medical terminology, dermatology a plus. Ability to speak other languages a plus. Working Conditions
Required to move from one location to another within and outside of the building; push, pull and reach; bend; sit for extended periods of time Ability to work 8-10+ hour shifts and be available for overtime when necessary. Must be able to speak and write English fluently. Ability to lift to 25 lbs.
On-Site Presence Required at least three days per week with the option to potentially work remotely two days per week following a successful in-person training plan.
Hours: TBD based upon department needs between the hours of 7:00am-5:30pm Monday - Friday as assigned.