Medical Authorization Specialist

2 weeks ago


Knoxville, Tennessee, United States Southeastern Retina Associates Full time
Job Title: Medication Authorization Coordinator

At Southeastern Retina Associates, we are seeking a highly organized and detail-oriented Medication Authorization Coordinator to join our team. This role is responsible for requesting authorizations from patient's health insurance plans or other 3rd party companies, ensuring timely and accurate processing of medication authorizations.

Key Responsibilities:
  • Request authorizations from patient's health insurance plans or other 3rd party companies
  • Check physicians' daily schedules for use of specialty drugs before scheduled appointment
  • Check for prior authorization requirements for any procedures or specialty drugs
  • Set up patients for Free Drug through respective Drug Company
  • Assist staff members and physicians with billing questions
  • Scan and import correspondence in Practice Management system
  • Provide documentation for each patient regarding pre-authorizations, pre-certifications, eligibility, and benefits that have been completed
  • Answer incoming calls from clinic staff to provide direction on treatment options
  • Audit and appeal any denied drug authorizations
  • Maintain current information regarding all payors
Requirements:
  • High School Diploma, required
  • Two years of medical related experience with knowledge of diagnosis codes (ICD10), procedure codes (CPT), injectable drug code (HCPCs)
  • Healthcare insurance knowledge and billing requirements knowledge and experience is necessary
Working Conditions:

This role requires frequent contact with staff members, physicians, and the public. Work may be stressful at times. Interaction with others is constant and interruptive. Occasional evening or weekend work as needed.

Southeastern Retina Associates reserves the right to revise or change job duties and responsibilities as the need arises. This job description does not constitute a written or implied contract of employment.

All employees are required to adhere to the SERA privacy practices as documented in the SERA Employee Handbook and all SERA HIPAA policies and procedures. Failure to comply may result in disciplinary action ranging from a warning to termination depending on the level of violation.



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