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Tailor your resume to this Clinical Prior-Authorization Specialist - CMA role.
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About the Role
Assists patients in the prior authorization process, including reviewing medications and imaging orders. Provides patients with information, services, and assistance.
Responsibilities
- 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.
- Communicates 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 a safe, secure, and healthy work environment by establishing and following standards and procedures; complying with legal regulations.
- 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.
Requirements
- One or more years of experience preferred.
- Certified Medical Assistant required.
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
Work Type
- Full Time Position
Education Level
- High school diploma or GED
Benefits
- Life Insurance
- Medical Insurance
- Dental Insurance
- Vision Insurance
- Retirement Plan
- Paid Time Off (PTO)
- Gym Membership
- Other supplemental options