Prior Authorization Specialist (Dermatology)

Overview

Anne Arundel Dermatology is a growing dermatology practice focused on delivering exceptional care across medical, surgical, and aesthetic skin health services.

Role Summary

The Prior Authorization Specialist plays a critical role in ensuring patients receive timely approval for medical treatments, procedures, medications, referrals, and diagnostic testing. This position works closely with patients, providers, insurance companies, pharmacies, and outside facilities to help streamline access to care.

Key Responsibilities

• Manage authorization requests for medications, specialty and biologic therapies, diagnostic testing, and other provider-ordered services.
• Verify insurance requirements, gather clinical documentation, and submit prior authorization requests through appropriate platforms.
• Monitor pending authorizations through determination and follow up on outstanding requests.
• Review denials, coordinate additional documentation, resubmissions, step-therapy requirements, and appeals.
• Coordinate outbound referrals to outside specialists and healthcare facilities.
• Arrange diagnostic testing and other ordered services, including facility coordination and follow-up on results.
• Serve as a point of contact for patients, providers, insurance companies, pharmacies, and outside facilities.
• Research payer requirements, formulary restrictions, and specialty pharmacy requirements.
• Maintain accurate tracking and documentation in the patient medical record.
• Collaborate with clinical and administrative teams and escalate urgent or unresolved issues as needed.