Medical Assistant/Medication Prior Authorization Specialist

Job Summary

The Medication Prior Authorization Specialist for a Gastroenterology (GI) specialty practice is responsible for managing and obtaining insurance approvals for GI-related medications. This role requires prior experience with medication authorizations, specialty drugs, and insurance requirements to ensure timely patient access to treatment and to minimize delays in care.

Key Responsibilities

• Initiate, submit, and manage medication prior authorizations for GI-specific medications (e.g., biologics, infusion therapies, specialty injectables)
• Review insurance coverage, formularies, and authorization criteria for prescribed GI medications
• Gather, review, and submit required clinical documentation, including GI office notes, endoscopy reports, pathology results, lab work, and imaging
• Communicate with GI providers regarding authorization requirements, coverage alternatives, and denials
• Track authorization status and follow up with insurance companies to ensure timely determinations
• Manage insurance denials and submit appeals, including supporting documentation and medical necessity letters
• Communicate authorization outcomes to providers, infusion centers, pharmacies, and patients
• Document all authorization activity accurately and thoroughly in the EMR
• Coordinate with specialty pharmacies and infusion centers to resolve authorization and dispensing issues
• Maintain up-to-date knowledge of GI medications, insurance policies, and authorization processes
• Ensure compliance with HIPAA, payer guidelines, and organizational policies

Requirements

• Proven experience in managed care or medical office settings, preferably with prior authorization responsibilities.
• Strong knowledge of medical terminology, medical records management, and medical coding, including CPT, ICD-9, ICD-10, and ICD coding systems.
• Experience in insurance verification processes within healthcare environments, such as dental or medical offices.
• Excellent communication skills for effective interaction with healthcare providers, insurance representatives, and patients.
• Office experience with proficiency in electronic health records (EHR) systems and documentation procedures.
• Ability to multitask efficiently in a fast-paced environment while maintaining attention to detail. Join our team as a Medication Prior Authorization Specialist and play a crucial role in ensuring patients receive the medications they need promptly! Your dedication will help improve health outcomes through precise coordination and expert knowledge of insurance protocols and medical coding standards.

Job Type: Full-time

Pay: $18.00 - $20.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Work Location: In person