Assistant Supervisor/Senior Clinical Administrative Assistant
CurrentTrain, and onboard new team members as needed. Provide direction to team members to ensure they understand their role and responsibilities. Assess individual and team performance, provide feedback and address issues. Resolve issues that require higher-level intervention Review medication prescriptions submitted by healthcare providers to determine whether they meet the insurance company's criteria for coverage. Verify the patient's insurance coverage and the specific requirements for medication coverage based on the insurance plan's formulary, policy guidelines, and medical criteria. Gather all necessary documentation, including medical records, lab results, and clinical notes, to support the prior authorization request. Complete and submit the necessary prior authorization forms, along with the gathered documentation, to the insurance company for review. Contact clinical staff, insurance companies, and patients to provide updates on the status of the prior authorization request, request additional information if needed, or communicate the outcome of the prior authorization.Prepare and submit appeals when prompted, providing additional clinical information or addressing any discrepancies that led to the denial. Maintain accurate and detailed records of all prior authorization requests, outcomes, communications, and other relevant information. Keep up to date with changes in ICD-10 codes, EMR systems (cover my meds, availity, and Carefirst, ect.) insurance policies, formularies, and medical guidelines to ensure accurate and efficient submission of prior authorization requests. Work closely with pharmacists, physicians, nurses, insurance representatives, and other healthcare professionals to facilitate communication and expedite the authorization process. Identify potential areas of improvement in the prior authorization process to streamline and enhance efficiency.
