Prior Authorizations and Patient Assistance Programs Specialist

Job Description

Job Description

Job Summary

The Healthcare Prior Authorizations and Patient Assistance Programs Specialist will be responsible for obtaining necessary prior authorizations for medications, imaging, and procedures, ensuring that all required documentation is submitted in a timely manner. This role also involves coordinating care for infusion patients and managing applications for patient assistance programs to ensure that patients have access to the medications and treatments they need. The ideal candidate will be self-motivated, proactive in completing tasks, and resourceful in researching insurance policies and other relevant information as needed.

Responsibilities

Medication Prior Authorizations:

• Review and process medication prior authorizations (PAs) for prescribed drugs.
• Ensure all necessary clinical documentation is provided to insurance companies to facilitate approval.
• Maintain clear and detailed records of PA requests and status updates.

Imaging and Procedure Prior Authorizations:

• Initiate and track prior authorizations for imaging studies (e.g., MRIs, CT scans) and medical procedures.
• Communicate with healthcare providers and insurance companies to obtain approval or additional information as needed.
• Follow up on pending authorization requests to expedite approval.

Appeal Letters:

• Draft and submit appeal letters for denied medication, imaging, or procedure prior authorizations.
• Work closely with physicians and clinical staff to gather required medical records and information for appeals.
• Monitor and track the status of appeals and update patients on outcomes.

Coordination of Infusion Care:

• Assist in coordinating infusion treatments for patients, including ensuring insurance approval for infusion medications.
• Liaise with infusion centers and patients to coordinate scheduling, treatment protocols, and insurance verifications.
• Address any issues related to infusion coverage or approvals in a timely manner.

Patient Assistance Programs:

• Obtain and submit required paperwork to pharmaceutical manufacturers or third-party organizations for program enrollment.
• Work with patients to ensure that they receive the financial assistance they need for prescribed medications.
• Maintain up-to-date knowledge of available assistance programs and help patients navigate the enrollment process.

Documentation and Compliance:

• Ensure that all patient data, authorization submissions, and follow-up documentation are compliant with HIPAA and other healthcare regulations.
• Track authorization and patient assistance program status using internal systems.
• Communicate clearly with patients, healthcare providers, and insurance companies to ensure a smooth process for all involved parties.

Self-Motivation and Research:

• Be self-driven and able to complete tasks independently with minimal supervision.
• Proactively research insurance policies, guidelines, and clinical requirements to ensure accurate and timely prior authorizations and appeal submissions.

Education:

• High School diploma or equivalent required.

Experience:

• 2+ years of experience in healthcare prior authorizations or a related administrative role, with experience in medication, imaging, and procedure authorizations.
• Experience with patient assistance programs and insurance verification preferred.

Skills:

• Strong understanding of healthcare insurance terminology, policies, and processes.
• Excellent written and verbal communication skills.
• Detail-oriented with excellent organizational skills.
• Ability to manage multiple tasks and deadlines simultaneously.
• Proficiency with healthcare management software and Microsoft Office Suite (Excel, Word, etc.).
• Knowledge of HIPAA regulations and patient confidentiality.
• Resourceful in researching insurance policies, medical guidelines, and patient assistance program options.

Physical Requirements:

• Ability to sit and work at a desk for extended periods.
• Must be able to communicate effectively via phone and email.