Communicate with payors via phone, fax, and electronic prior authorization systems to obtain approvals for prescribed medications and services. Review electronic medical records and prior authorization software to identify medications requiring authorizations. Respond to outstanding authorization requests and maintain accurate records of medical policies. Support patients taking high-risk and biologic medications by coordinating renewals and routine screenings. Maintain timely record-keeping of all electronic medical records and prior authorization actions. Track prior authorizations including data entry and reporting. Ensure timely processing and communicate authorization status to physicians and their teams. Predict payor decisions and advise physicians on required supporting documentation. Appeal authorization denials as directed by physicians. Process renewals for expiring authorizations and screen refill requests. Stay knowledgeable about manufacturer assistance programs and collaborate with drug vendors and sales representatives.
The role requires regular and reliable attendance and may involve performing additional duties as assigned.
High School Diploma or equivalent required. Minimum of 2 years experience in healthcare or prior authorizations. Experience in insurance verification (1 year required) and medical billing (1 year preferred). Knowledge of electronic medical records and practice management systems. Proficiency in Microsoft Office applications.
401(k) plan, dental insurance, health insurance, paid time off.
Location
New York, New York, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
1 week ago