MA - Prior Authorization

Medical Assistant – Prior Authorization - Full Time Position Summary Boone Memorial Health is seeking a detail-oriented and organized Medical Assistant (MA) – Prior Authorization to coordinate prescription medication refill requests and insurance prior authorizations in a timely and accurate manner. This position works closely with providers, Medical Assistants, pharmacies, patients, and insurance companies to ensure medication requests are processed in accordance with clinic policies, provider instructions, and insurance requirements.

The MA – Prior Authorization serves as an important liaison between patients, pharmacies, insurance companies, and the clinical team. The position requires strong communication, organizational, and follow-up skills, along with a commitment to maintaining patient confidentiality and complying with HIPAA and all applicable organizational policies and regulations.

Essential Functions Reasonable accommodations may be made to enable individuals with disabilities to perform these essential functions.

Medication Refills Receive, review, and process medication refill requests received through telephone calls, pharmacy requests, electronic messages, and other approved methods.

Review medication lists, allergies, last office visits, upcoming appointments, and available clinical information before forwarding refill requests to the appropriate provider.

Process refill requests according to established clinic protocols and provider instructions.

Route refill requests to the appropriate provider for approval when required.

Identify medications requiring an office visit, laboratory monitoring, or other clinical follow-up before a refill can be authorized.

Contact patients regarding refill issues, required appointments, laboratory testing, or additional information needed to process requests.

Communicate with pharmacies regarding prescription clarification, quantities, directions, and other nonclinical issues.

Follow up on pending refill requests to help prevent unnecessary delays in patient care.

Accurately document all refill-related communications and actions in the electronic health record (EHR).Monitor refill requests to ensure completion within established turnaround times.

Notify appropriate clinical staff or providers of urgent medication-related concerns.

Obtain and provide Board of Pharmacy reports to the provider when requesting controlled substances.

Prior Authorizations Receive and process medication prior authorization requests from pharmacies, insurance companies, patients, and providers.

Review insurance requirements and identify the information needed to complete prior authorization requests.

Gather required clinical information from patient medical records and provider documentation.

Complete and submit prior authorization requests through insurance portals, electronic systems, fax, or telephone, as appropriate.

Communicate with insurance companies regarding authorization requirements and request status.

Follow up on pending authorizations and document updates in the EHR.Notify providers when additional clinical information, documentation, or alternative medications are required.

Communicate authorization decisions to appropriate clinical staff and patients.

Assist with appeals, additional documentation, and patient assistance programs as requested by the provider or insurance company.

Maintain an organized tracking system for pending, approved, denied, and appealed authorizations.

Monitor authorization expiration dates and assist with renewal requests as appropriate.

Ensure all authorization correspondence, approvals, denials, and follow-up activities are appropriately documented.

Perform other duties as assigned by the Clinic Manager or Clinical Supervisor.

Education and…