Prior Authorization Coordinator

Overview At Adult & Pediatric Dermatology, PC, we are dedicated to creating a caring, professional, patient-centered experience for state-of-the-art medical, surgical and aesthetic dermatology and dermatopathology. By treating every patient as an individual, we seek to customize a plan of care to match each patient’s needs and priorities. We strive to deliver exceptional dermatologic care by making comprehensive dermatology services available and accessible to our patients within their communities. We support our primary care healthcare providers with easy access and rapid communication. We empower our patients with information to participate in the goal of achieving healthy skin. Our highly-trained providers and staff work as a team to provide excellent, coordinated, cost-effective dermatology care. Our team members enjoy a world-class benefits plan with a broad range of options including: Medical plans with HMO or PPO options Dental plan Healthcare Savings Account (HSA) 401k plan with generous match Employee Assistance Plan Additional benefit options such as short-term disability, accident, cancer indemnity and life insurance through AFLAC This is a primarily remote position but you must reside in MA, NH, RI or CT. Responsibilities Under the general supervision of the Clinical Call Center Manager, the Prior Authorization Coordinator will be responsible for medication and procedure Prior Authorization process including Prescription Refills. Essential Duties and Responsibilities including but not limited to: Interview patients to determine how they can be assisted in receiving authorizations for their medication and procedures Process necessary documentation to expedite approvals and ensure that appropriate follow-up is performed Receive requests for pre-authorizations and ensure that they are properly and closely monitored Obtain authorization from insurances requiring authorization via telephone, facsimile. or online systems while maintaining compliance to medical record confidentiality regulations. Review accuracy and completeness of information requested and ensure that all supporting documents are present Process referrals and submit medical records to insurance carriers to expedite prior authorization processes Manage correspondence with insurance companies, physicians, specialists and patients as required Manage denials and submit appeals to get them approved from insurance companies Create accurate and consistent documentation in patient’s records to ensure that pre-authorization information is properly updated. Record all prior authorizations phone calls, documents and authorization numbers in Centricity. Skills, Knowledge, & Abilities: Knowledge of online authorization systems and status review. Must possess excellent computer skills to input and retrieve clinical information. Ability to track in-process authorizations from multiple sources. Knowledge of medical terminology. Works efficiently with minimal supervision, exercising independent judgment within stated guidelines. Demonstrates effective interpersonal skills which promote cooperation and teamwork. Strong Customer Service skills required to communicate with patients, family members, physicians, and other health care providers, as well as insurance companies and team members in a positive and professional manner. Ability to withstand varying job pressures, organize/prioritize related job tasks, and excellent attention to detail. Excellent public relations skills and demonstrated ability to communicate in calm, businesslike manner.Ability to multitask, learn new skills and adapt to change Maintains a ONETeam mindset using the foundation of our core values, the 3Ps: Positivity, Productivity, and Professionalism. Support APDerm’s mission and culture of high-quality standards by carrying out applicable policies, procedures and established industry standards, laws and regulations. Examples include adhering to privacy and data protection practices, ensuring a safe workplace, and reporting observed or suspected behavior and actions that do not meet APDerm standards. Complete all assigned required training by the deadline including, but not limited the Code of Conduct, Privacy & Data Security, and OSHA. Qualifications High School diploma/ GED required Current Certified Medical Assistant certificate preferred Certified and licensed pharmacy technician preferred The salary for this role will range from USD $20.00 to 27.14 per hour based on full-time employment. Salary offers are based on a wide range of factors including but not limited to years of experience, location, relevant skills, training, education, etc. Certain roles may be eligible for performance-based incentive compensation and/or long-term incentives. APDerm supports your life's needs through an extensive offering comprehensive, competitive and inclusive set of health, financial and other benefits that support your total well-being. APDerm is proud to be an equal employment opportunity and affirmative action workplace. We consider all qualified applicants without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, national origin, military and veteran status, disability, genetics, or any other category protected by federal law or APDerm policy. Please email humanresources@apderm.com if you need a disability accommodation for any part of the employment process.