Job Title
Medication Authorization Coordinator

Reports to
Billing & Coding Manager

Summary of Responsibilities
Requests authorizations from patient’s health insurance plans or other 3rd party companies.

Lists of Responsibilities/Duties are as follows but not limited to

Check physicians’ daily schedules for use of specialty drugs before scheduled appointment

Check for prior authorization requirements for any procedures or specialty drugs

Set up patients for Free Drug through respective Drug Company

Assist staff members and physicians with billing questions

Scan and import correspondence in Practice Management system

Provide documentation for each patient regarding pre-authorizations, pre-certifications, eligibility, and benefits that have been completed. Including any task that are required from clinic staff to ensure correct payment for procedures and specialty drugs

Answer incoming calls from clinic staff to provide direction on treatment options

Appeal any denied drug authorizations

Act as liaison person between all payors, patients, physicians, and staff to resolve any outstanding claims

Maintains current information regarding all payors

Minimum Education Requirements

High School Diploma, required

Minimum Background Requirements

Two years of medical related experience with knowledge of diagnosis codes (ICD10), procedure codes (CPT), injectable drug code (HCPCs). Healthcare insurance knowledge and billing requirements knowledge and experience is necessary

Minimum Demonstrated Skills

• Demonstrate excellence in organizational skills.
• Demonstrate excellence in communication skills.
• Demonstrate ability to effectively convey ideas and information.
• Creative idea-generating individual with excellent follow through abilities.
• Demonstrate ability to work cooperatively with others.

The American with Disabilities Act requires that reasonable accommodations be made for qualified individuals to help perform the required duties and tasks of the position. Please let us know at the time you apply for a position if you will need any special accommodations.

HIPAA All employees are required to adhere to the SERA privacy practices as documented in the SERA Employee Handbook and all SERA HIPAA policies and procedures. Failure to comply may result in disciplinary action ranging from a warning to termination depending on the level of violation

TYPICAL PHYSICAL DEMANDS:

Work may require sitting for long periods of time; also stooping, bending, and stretching for files and supplies. Occasionally lifting files or paper weighing up to 30 pounds. Requires manual dexterity sufficient to operate a keyboard, operates a calculator, telephone, copier and other office equipment as necessary. It is necessary to view and type on computer screens for long periods.

TYPICAL WORKING CONDITIONS:

Work is performed in an office environment. Work involves frequent contact with staff members, physicians and the public. Work may be stressful at times. Interaction with others is constant and interruptive. Occasional evening or weekend work as needed.

SERA reserves the right to revise or change job duties and responsibilities as the need arises. This job description does not constitute a written or implied contract of employment.

HIPAA:

All employees are required to adhere to the SERA privacy practices as documented in the SERA Employee Handbook and all SERA HIPAA policies and procedures. Failure to comply may result in disciplinary action ranging from a warning to termination depending on the level of violation.

This description provides only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve. It is not intended to be all-inclusive. The employee may be required to perform other reasonably related business duties as assigned.