Prior Authorization Specialist

Biologics and Medications Prior Authorization Specialist

Position Purpose

The Prior Authorization Specialist is responsible for ensuring that patient’s biologic drugs and medications are covered and authorized under a patient’s insurance plan. Essential Job Functions

· Works effectively with insurance companies to get all biologic drugs and other medications approved.

· Pre-Authorization initiated same business day.

· Communicates effectively with patients, physicians and clinical staff on the status of the Prior Authorization.

· Communicates with the pharmacies on Prior Authorization approvals.

· Reading insurance clinical guidelines to ensure the biologic meets clinical guidelines and the patient has completed appropriate step-therapy.

· Uses the EMR to document the Prior Authorization approval or denial.

· Works with CoverMyMeds daily and maneuver the website effectively.

· Uses website portals to obtain benefits and submit Prior Authorization, when applicable.

· Understands patient assistance programs and free drug programs and can assist patients in signing up.

· Communicates effectively with other staff at outside infusion facilities.

· Maintains confidentiality of patient records.

· Communicates with Document information in appropriate fields within the EMR such as guarantor account, referral notes, and appointment notes.

· Cover other areas of Prior Authorization Department, as needed.

· Understand and adhere to all HIPAA regulations to maintain our patients’ privacy.

· Requires regular, predictable attendance.

· Flexibility is essential for success with CFG and on occasion, our employees may be asked to complete projects and tasks that could be outside of their

normal scope of duties.

Required Competencies

· Effective Communication—Ability to communicate clearly both verbally and in writing with diverse groups; understanding of and ability to explain insurance and financial information to patients.

· Documentation and Information Recording—Possess excellent attention to detail as well as data entry skills. Accurate entry of patient information; and ability to investigate, ask follow-up questions, or track timelines to resolve issues that arise. Maintain confidential information.

· Customer Service—Listen attentively; respond to questions appropriately and timely. Possess kind and pleasant demeanor as well as demonstrate patience over the phone. Ability to take direction as needed.

· Time Management—Must be able to work under pressure and complete multiple projects or tasks according to established timeframes. Enjoy working in a high-energy, fast-paced environment. Demonstrate resourcefulness and creative problem-solving as needed.

· Professionalism—Build solid working relationships and be support of co-workers; foster a friendly work environment, focused on providing patient access.

· Demonstrated comfort with Windows-based computer systems.

Required Experience

· High school graduate or equivalent.

· Medical office experience – 3 years.

· Prior authorization—1 year.

· Knowledge of medical insurance terminology (i.e., Deductible, Co-Insurance, Out-of-pocket max, etc.).

· Maintains confidential and sensitive information.

· Knowledge of ICD-10 and CPT codes needed for authorization and coverage purposes.

Preferred Experience

· Epic EMR

· Biologic Prior Authorization experience.

Performance Measurement

· 98 % accuracy rate for obtaining Prior Authorization.

· Patient cases are touched and continually worked 48 hours after receiving request.

· Employee is generally regarded as polite and helpful by patients and co-workers.

Working Conditions and Physical Requirements

· Ability to walk, stand, stoop, bend, or sit for extended periods of time.

· Physical demands: percentage of time spent in each activity (estimate)

o Walking 20% - assisting patients, delivering information personally to other departments, collaborating with other department employees.

o Sitting 80% - answering the telephone, scheduling appointments and procedures in the call center, working at the front desk, working on the computer.

· Number of pounds that must be lifted, carried, pushed or pulled: up to 30lbs.

· Climbing on step ladders to reach top shelves, stooping, kneeling, crouching, reaching, fingering (like keyboarding, controls on a scanner, fax, etc.)

· Ability to speak clearly to be understood by our patients and employees.

· Ability to hear within normal range. Able to hear patients on the phone in a noisy environment.

· Acuity near and far. Ability to see within normal parameters, and to distinguish colors.

· Ability to work for extensive periods at computer keyboarding.

· Works in a well-lit heated/air-conditioned environment. Temperatures between 68 and 74 degrees.

· Work may involve exposure to communicable diseases, medicinal preparations and other conditions common to a clinic environment.

Equipment used

Computer, printer, multi-line telephone, headset, fax machine, scanner, postage machine Benefits

The Centers for Gastroenterology is proud to offer medical, dental, vision, life insurance, identity theft protection, a monthly HSA contribution, a 401(k) option with employer matching, 7 paid holidays, a personal holiday, a generous PTO package, a quarterly bonus program, an Employee Assistance program, voluntary accident and critical illness benefits, professional development opportunities, and of course, an awesome work environment! Equal Employment Opportunity

Centers for Gastroenterology is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender

identity or expression, sexual orientation, national origin, genetics, disability, age, military, or veteran status

Job Type: Full-time

Pay: $18.67 - $22.82 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Health savings account
• Paid time off
• Professional development assistance
• Vision insurance

Weekly day range:

• Monday to Friday

Experience:

• Insurance verification: 1 year (Preferred)
• Medical billing: 1 year (Preferred)
• Medical office: 1 year (Required)

Ability to Relocate:

• Fort Collins, CO 80525: Relocate before starting work (Required)

Work Location: Hybrid remote in Fort Collins, CO 80525