Medical Assistant Prior Authorization Specialist
Overview
The role involves owning prior authorizations for specialty medications within a supportive collaborative culture that prioritizes people. Responsibilities include managing high volume authorizations and driving efficient revenue cycle processes.
What You'll Do11
- 1Manage approximately 30+ active prior authorizations
- 2Process complex medication prior authorizations
- 3Review clinical documentation payer requirements step therapy and medical necessity criteria
- 4Verify medical and pharmacy benefits determine in network and out of network coverage
- 5Communicate with insurance companies regarding authorization requirements and case status
- 6Identify missing documentation and work with providers to obtain necessary clinical information
- 7Manage denials appeals and escalated authorization cases
- 8Accurately document case activity and follow up
- 9Prioritize multiple authorizations and deadlines
- 10Research and resolve complex insurance and coverage issues
- 11Collaborate closely with providers clinical staff and internal teams
Requirements11
- 1Medical Assistant certification or formal MA training required
- 22–3+ years of Medical Assistant experience
- 3Direct experience processing prior authorizations for specialty medications required
- 4Experience handling denials and appeals
- 5Strong knowledge of insurance benefits and payer processes
- 6Ability to understand and interpret clinical documentation
- 7Excellent organization documentation and follow through
- 8Effective communication and problem solving skills
- 9Ability to manage a high volume caseload and multiple deadlines
- 10Preferred experience in specialties such as Rheumatology Gastroenterology Dermatology Neurology Immunology
- 11Experience with Salesforce WeInfuse AdvancedMD EMRs CRMs payer portals or similar authorization systems
Salary Insight
$50 - $58k per year
Location
Required Skills
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