Biologics Coordinator/Medication Prior Author

ADP, Inc.; Dahlonega (GA); On-site; USD 48,712,000 - 68,770,000; Full time

Benefits offered by this job

Paid Time Off (PTO)

Medical Insurance

Vision Insurance

Life Insurance

Aflac Supplemental Insurance

401(k) Retirement Plan

Supportive team environment

Job summary

Cleaver Dermatology & Aesthetics is seeking a detail-oriented Biologics & Medication Prior Authorization Specialist to join our Dermatology team, managing prior authorizations for dermatology meds, including biologics and specialty therapies.

The ideal candidate is highly organized, communicates effectively with patients, pharmacies, providers and insurers, and will take ownership of the authorization process from start to finish to ensure timely access to medications.

Qualifications

• Previous experience with prior authorizations, medication authorizations, specialty medications, or insurance verification preferred
• Dermatology experience is a plus
• Experience working with biologics is highly preferred
• Strong understanding of health insurance processes and terminology

Responsibilities

• Manage prior authorizations for dermatology medications, including biologics, specialty medications, and other prescription therapies
• Submit and process medication prior authorizations through insurance portals, electronic systems, and other required platforms
• Review insurance requirements and determine necessary documentation for medication approvals
• Gather supporting clinical documentation, including office notes, diagnosis information, previous treatments, medication history, and treatment failures
• Communicate with providers and clinical staff regarding prior authorization requirements and necessary documentation
• Track pending, approved, denied, and appealed prior authorizations

Skills

Prior authorizations

Medication authorizations

Insurance verification

Dermatology experience

Biologics experience

EMR experience

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Full Time Clinical Dahlonega, GA, US

Salary Range: $17.00 To $24.00 Hourly

Cleaver Dermatology & Aesthetics is seeking a detail-oriented and organized Biologics & Medication Prior Authorization Specialist to join our Dermatology team!

This position is responsible for managing the prior authorization process for dermatology medications, including biologics and specialty medications. The ideal candidate is highly organized, comfortable working with insurance companies, and able to effectively communicate with patients, pharmacies, providers, and insurance representatives.

This is an important role within our practice and requires someone who cantake ownership of the authorization process from start to finish, follow up consistently, and ensure patients receive their medications as efficiently as possible.

Position Responsibilities

• Manage prior authorizations for dermatology medications, including biologics, specialty medications, and other prescription therapies
• Submit and process medication prior authorizations through insurance portals, electronic systems, and other required platforms
• Review insurance requirements and determine necessary documentation for medication approvals
• Gather supporting clinical documentation, including office notes, diagnosis information, previous treatments, medication history, and treatment failures
• Communicate with providers and clinical staff regarding prior authorization requirements and necessary documentation
• Communicate with insurance companies and pharmacy benefit managers regarding authorization status and requirements
• Track pending, approved, denied, and appealed prior authorizations
• Follow up regularly on outstanding authorizations to prevent unnecessary delays in patient care
• Process medication-related paperwork and maintain accurate documentation in the patient's medical record
• Assist with appeals and requests for reconsideration when medications are denied
• Coordinate with specialty pharmacies and medication manufacturers as needed
• Assist patients with questions regarding medication approvals, pharmacy coordination, and next steps
• Help patients navigate insurance-related barriers to obtaining prescribed medications
• Monitor authorization expiration dates and assist with renewals when necessary
• Maintain accurate records and ensure all authorization activity is documented appropriately
• Work closely with providers, clinical staff, pharmacies, and insurance companies to resolve medication access issues
• Protect patient privacy and maintain HIPAA compliance at all times
• Perform other administrative and clinical support duties as needed

Qualifications

• Previous experience withprior authorizations, medication authorizations, specialty medications, or insurance verification preferred
• Dermatology experience is a plus
• Experience working with biologics is highly preferred
• Strong understanding of health insurance processes and terminology
• Comfortable navigating insurance and pharmacy benefit websites and portals
• Excellent organizational and time-management skills
• Strong attention to detail and accuracy
• Excellent written and verbal communication skills
• Ability to effectively communicate with insurance companies, pharmacies, providers, and patients
• Ability to manage multiple authorizations and deadlines simultaneously
• Comfortable working independently while also collaborating with a clinical team
• Strong problem-solving and follow-up skillsl>
• Experience with electronic medical records (EMR) preferred
• Must be dependable, professional, and able to maintain patient confidentiality

What We Offer

• Paid Time Off (PTO)
• Medical Insurance
• Vision Insurance
• Life Insurance
• Aflac Supplemental Insurance
• 401(k) Retirement Plan
• Supportive team environment
• Opportunity for professional growth within a growing private medical practice

The Ideal Candidate

We are looking for someone who isorganized, persistent, detail-oriented, and proactive. The right candidate understands that obtaining medication approval can directly impact a patient's care and is willing to follow through until an authorization is resolved.

You should be comfortable making phone calls, navigating insurance portals, researching requirements, communicating with multiple parties, and keeping detailed records.Strong follow-up and attention to detail are essential.

Prior experience with dermatology biologics and medication prior authorizations is highly valued, but we are willing to train the right candidate who has strong medical office, insurance, or clinical experience.

If you are looking for an opportunity to become an important part of a growing dermatology practice and help patients access the medications they need,we would love to hear from you!