Prior Authorization Specialist - Clinical/Office
full-time•Wyomissing
About this role
Description
Summary/Objective
Effectively obtain insurance authorizations for patients prescribed medication
Essential Functions
- Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Responsible for authorizations in multi-provider practice.
- Obtain patient insurance information and contact insurance carriers online or by phone to verify requirements.
- Research clinical information from medical record needed to obtain prior authorizations from insurance companies or patient assistance programs.
- Communicating authorizations to patients and physicians explaining approvals or denials for medication when needed.
- Field any phone calls and emails related to authorizations.
- Establish relationships with drug companies.
Competencies
- Excellent organizational and problem-solving skills
- Demonstrates well developed interpersonal/communication skills necessary to interact effectively with internal and external customers
- Ability to evaluate a variety of patient situations and make timely decisions
- Must demonstrate ability to work in fast-paced, deadline-oriented environment, with minimal supervision, with the ability to meet deadlines is a must with constant communication required
- Strong computer skills, including basic keyboarding, experience with Microsoft Office software (Outlook, Work, Excel)
- Ability to support and understand authorization processes
- Knowledge and/or willingness to understand insurance guidelines and requirements to successfully complete prior authorizations/pre-determinations
Supervisory Responsibility
None
Work Environment
This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.
Physical Demands
The employee is occasionally required to stand; walk; sit; and reach with hands and arms. Repetitive hand movement due to extended computer use. The employee must occasionally lift and/or move up to 25 pounds.
Position Type/Expected Hours of Work
Full Time / Monday – Friday
Travel
None
Work Authorization/Security Clearance
Must be authorized to work in the US for any employer
AAP/EEO Statement
US Digestive Health is an Equal Opportunity Employer. USDH does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, non-disqualifying physical or mental disability, national origin, veteran status or any other basis covered by appropriate law. All employment is decided based on qualifications, merit, and business need
Other Duties
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
Requirements
- High School Diploma or GED equivalent
- Minimum 3-5 years of experience in customer service preferred but not required.
- Prefer previous Medication Authorization responsibilities
- Allscripts EMR program a plus
What you'll do
- The Prior Authorization Specialist is responsible for obtaining insurance authorizations for patients prescribed medication and communicating the outcomes to patients and physicians. This includes verifying insurance requirements and researching clinical information from medical records.
About US Digestive Health
US Digestive Health works with world-class physicians around the Greater Philadelphia area, as well as Lancaster, Berks, and Carlisle counties, to provide all the backend services and operations management so the physicians can focus on their patients.
As an empowering resource to our physician partners and a resource to them, allowing them to focus on compassionate and exceptional care to their patients, US Digestive Health is committed connecting communities to better digestive health by providing easy and convenient access to comprehensive gastroenterology services.
By extending our network of locations and providers, we ensure that patients can be seen at the right time, in the right place, by the right provider. Our goal is to ensure that our physician partners can make diagnoses as quickly and accurately as possible in order to expedite treatment and reduce both pain and anxiety.
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Frequently Asked Questions
What does a Prior Authorization Specialist - Clinical/Office do at US Digestive Health?
As a Prior Authorization Specialist - Clinical/Office at US Digestive Health, you will: the Prior Authorization Specialist is responsible for obtaining insurance authorizations for patients prescribed medication and communicating the outcomes to patients and physicians. This includes verifying insurance requirements and researching clinical information from medical records..
Is the Prior Authorization Specialist - Clinical/Office position at US Digestive Health remote?
The Prior Authorization Specialist - Clinical/Office position at US Digestive Health is based in Wyomissing, Pennsylvania, United States. Contact the company through Clera for specific work arrangement details.
How do I apply for the Prior Authorization Specialist - Clinical/Office position at US Digestive Health?
You can apply for the Prior Authorization Specialist - Clinical/Office position at US Digestive Healthdirectly through Clera. Click the "Apply Now" button above to start your application. Clera's AI-powered platform will help match your profile with this opportunity and guide you through the application process.