Medication/Prior Authorization Specialist Job at CMU Health, Saginaw, MI

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  • CMU Health
  • Saginaw, MI

Job Description

Join Our Team as a Medication & Prior Authorization Specialist!

Are you a detail-oriented healthcare professional with a passion for streamlining patient care? Do you thrive in fast-paced environments where accuracy and efficiency are key? If so, we want you to join our dynamic outpatient clinic team as a Medication Prior Authorization Specialist!

 

What You’ll Do:

  • Review and process prior authorization requests for medical procedures, tests, medications, and treatments according to insurance guidelines and clinic protocols.
  • Verify patient insurance coverage and eligibility for requested procedures or treatments.
  • Communicate with insurance companies to obtain necessary authorizations and resolve coverage issues.
  • Maintain accurate records of requests, approvals, denials, and appeals, ensuring clear documentation of communication with insurance companies and healthcare providers.
  • Provide patients with updates and guidance on authorization requirements and financial responsibilities.
  • Collaborate with healthcare providers, nurses, and administrative staff to coordinate patient care and ensure compliance with insurance requirements.
  • Prepare and submit appeals for denied authorizations, advocating for patients’ medical needs.
  • Stay updated on insurance policies, regulations, and industry trends related to prior authorization processes.
  • Identify opportunities for process improvements and efficiency enhancements in prior authorization management.

 

What You Bring:

  • Education : High school diploma required; Associate degree preferred.
  • Experience : Minimum of 2 years in prior authorization management in a healthcare setting, preferably in an outpatient clinic or medical office.
  • Skills : Excellent communication skills (verbal and written), strong organizational and time management skills, ability to work independently and prioritize tasks effectively.
  • Preferred Knowledge : Familiarity with medical billing processes and revenue cycle management is a plus.

 

Why You’ll Love Working Here:

  • Be part of a supportive team that values your skills and dedication.
  • Opportunities for professional growth and development.
  • A welcoming and inclusive work environment.

 

Ready to Make a Difference? Apply Now!

CMU is an AA/EO institution, providing equal opportunity to all persons, including minorities, females, veterans, and individuals with disabilities.

 

Job Tags

Full time,

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