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Why You'll Love This Job

 

Position Summary: Biologic Prior Authorization Specialist is an individual who manages a patient’s journey from prescription to drug acquisition. This role navigates the complexities of patient access on behalf of those prescribed biologics.  Responsible for communicating with office staff, providers, insurance providers, completing enrollment forms, reviewing benefit verifications, submitting prior authorizations, directing patient assistance and bridge programs, and coordinating all efforts of specialty pharmacies and manufacturer HUBs under the direction of the Biologic Program Manager. Ability to work efficiently in a fast-paced environment while maintaining accuracy. This position offers the opportunity to contribute to the healthcare industry while ensuring patients receive timely authorizations for necessary treatments. If you possess the required qualifications and are looking to make a difference in patient care, we encourage you to apply for this rewarding role.

Licensure/Certification/Registration: LPN/Medical Assistant Certification

Education/Qualifications:

High school diploma or general education degree (GED) is required.

  • Minimum of 1-2 years of experience in a medical office or healthcare setting, with prior experience in prior authorization
  • Knowledge of medical terminology, coding (ICD-10, CPT), and insurance policies
  • Able to prioritize tasks, understand the providers instruction, and know when to seek information or advice.
  • Excellent communication skills, both written and oral
  • Proficient computer skills including word processing, data entry, excel.
  • Must have ability to communicate professionally and effectively with management, co-workers, hub personnel, as well as vendors and other third parties.

 

Job Responsibilities:

  • Communicate professionally and effectively with management, co-workers, hub personnel, as well as vendors and other third parties.
  • Enroll patients with manufacturer HUB for insurance verification/benefit investigation.
  • Contact insurance carriers to verify patient’s insurance eligibility, benefits, and PA requirements
  • Request, track and obtain pre-authorization/prior determination from insurance carriers prior to services being performed.
  • Enroll patients for copay assistance/patient assistance programs.
  • Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations.
  • Communicate any insurance changes or trends among team.
  • Maintains a level of productivity suitable for the department.
  • Clearly document all communications and contacts with providers and personnel in standardized documentation requirements, including proper format
  • Other duties as assigned.

Job Type: Full-time

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