Prior Authorization Coordinator

TIDEWATER PHYSICIANS MULTISPECIALTY GROUP P C • Newport News, VA

1d • Onsite

About The Position

A Coordinator for Rheumatology pharmaceutical medications manages the process of getting biologic medications to patients by handling prior authorizations, insurance verification, and patient support. Key responsibilities include coordinating with healthcare providers, pharmacies, insurance companies, managing prescription orders, and tracking patient treatment schedules to ensure timely access to therapy. The role requires strong organizational skills, attention to detail, and excellent communication to assist patients navigate financial aid and medication education.

Requirements

• Previous experience submitting and completing authorizations for medications and biologics via phone, CoverMyMeds, Pharmaceutical portals, Availity, Payer websites, and Samacare.
• Strong understanding of managed care principles and practices.
• Familiarity with medical terminology, medical coding, and insurance verification processes.
• Proficient in using electronic health record (EHR) systems and other relevant software applications.
• Excellent organizational skills with attention to detail.
• Ability to work independently as well as part of a team in a fast-paced environment.
• Strong communication skills, both written and verbal, to effectively interact with various stakeholders.
• Work full time 40 hours in office.
• Must have an active Medical Assistant Certification (CMA, CCMA, NRCMA, NCMA, or RMA) or Licensed Practical Nurse license.
• At least Two (2) years’ experience in a medical environment

Responsibilities

• Initiate and manage prior authorizations: Prepare and submit all necessary paperwork to insurance companies to get approval for biologic medications.
• Coordinate medication delivery: Ensure timely and accurate delivery of medications, including managing prescription orders and coordinating with specialty pharmacies.
• Patient support and education: Communicate with patients regarding approvals and denials, explain medication administration, and assist with financial assistance programs and copay cards.
• Maintain patient records: Document all communication with patients and providers in the electronic medical record (EMR) system.
• Collaborate with internal and external teams: Work with providers, office staff, and pharmaceutical representatives to ensure smooth patient access to therapy.
• Track and monitor patient treatment: Keep track of patient treatment plans, upcoming appointments, lab studies, and re-certifications for continued therapy.

What This Job Offers

• Job Type: Full-time
• Education Level: No Education Listed