
Medical Clearance Coordinator
1 week ago
The primary function of a Prior Authorization Specialist involves managing prior authorization requests for medications, ensuring that all submissions meet insurance requirements. Key responsibilities include submitting, tracking, and following up on these requests to facilitate timely processing.
A successful candidate in this role will possess excellent leadership skills, strong communication abilities, and expertise in prior authorization operations. They must be proactive in identifying issues, resolving them efficiently, and collaborating with various stakeholders, including pharmacies and providers.
This position requires a high level of organizational skill, attention to detail, and ability to manage multiple tasks simultaneously. The ideal candidate should be able to work independently, make sound decisions, and adapt to changing circumstances.
Key Responsibilities:- Submit, track, and follow up on prior authorization requests for medications.
- Ensure all requests meet insurance requirements before submission.
- Request necessary documentation from providers (chart notes, prescriptions).
- Coordinate with pharmacies and providers to ensure prior authorizations are processed in a timely manner.
- Submit PA requests via Cover My Meds, fax, or phone.
- Provide supporting clinical notes as required to the insurance company.
- Follow up on pending requests to prevent delays.
- Review denial reasons and gather additional documentation.
- Resubmit or appeal requests when appropriate.
- Document all interactions, requests, approvals, and denials in the CRM.
- Update patients on PA status when needed.
- Educate patients about expected timelines, insurance requirements, and alternative options if coverage is denied.
- Follow HIPAA guidelines to protect patient information.
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Medical Billing Drafting Coordinator
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Medical Biller
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Medical Billing
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