Medication Authorization Specialist (MA) (Full-time)

Company: Boulder Medical Center
Location: Boulder
Posted on: January 9, 2022

Job Description:

Job DescriptionDo you enjoy working with friendly and helpful people in a positive work environment? Are you ready to embrace a career that offers a variety of learning opportunities? Are you looking to make a positive impact on peoples' lives in our community?Consider a career in the medical field at Boulder Medical Center (BMC). We're an independent, multi-specialty, outpatient network of providers and staff dedicated to engaging our patients in high-quality, compassionate health care. For over 70 years, BMC has been locally owned and operated, providing exceptional medical care to patients across the northwestern Front Range and surrounding communities. This unique business model is why many of our employees come and stay!Job SummaryBoulder Medical Center is currently seeking a Medical Assistant (MA) to work as a Medication Authorization Specialist in our Referral and Authorizations Department. This position will work 40 hours per week, Monday - Friday, 8 am - 4:30 pm, and is benefit eligible.Job Duties: Performs daily review of incoming requests (faxed or electronic) for pre-authorizations for prescription medications and biologics for insurance products.Handles pre-certification process required by most insurance companies for non-formulary medications; Completes correct documentation in patient's medical chart.Responds to phone calls from BMC physicians, nurses, and staff with managed care insurance questions regarding medications, investigates problems or inquiries by contacting appropriate insurance company, and communicates action or resolution to staff in a timely and professional manner.Answers routine managed care insurance questions from patients referring them to the appropriate insurance company or to their employer when necessary for further benefit information or interpretation of policy.Communicates with patient to address and/or clarify problems or concerns; Communicates action back to ordering provider in a timely manner.Investigates and prepares appeals when claims are denied; Notifies health plan with appeal and notifies patient of appeal process and outcome.Works closely with BMC's insurance companies via phone, fax, or written correspondence regarding effective/termination dates and pre-authorization problems; Researches source documents, including review of patient's medical chart, submits information necessary to resolve initial inquiry and receive payment.Competently operates the Electronic Medical Records (EMR) system; Attends mandatory EMR training and participates in on-going EMR learning opportunities.Experience and SkillsSkills and Abilities:Must be knowledgeable about managed care insurance rules and regulations in order process referrals and pre-authorizations.Must be able to analyze detailed breakdowns of applicable managed care insurance coverage and use judgement and initiative in researching questionable charges and coverage.Must have accurate typing skills, strong computer knowledge and experience operating office machines such as printers and fax machines.Must possess basic math aptitude, professional manner, tact, pleasant telephone voice, ability to initiate correspondence using appropriate grammar, etc., ability to communicate appropriate insurance policy rules to patients (for managed care plans).Education:Holds an active license for either Medical Assisting or LPN.Previous Experience:1-2 years' experience working with managed care insurance rules and regulations or equivalent.Demonstrated working knowledge of ICD-10 coding.Salary Range$17.36 - 24.61/hour; depending on experience

Keywords: Boulder Medical Center, Boulder , Medication Authorization Specialist (MA) (Full-time), Other , Boulder, Colorado