Biologics Prior Authorization Specialist — Dermatology Access

Cleaver Dermatology & Aesthetics; Dahlonega (GA); On-site; USD 52,000 - 70,000; Full time

Benefits offered by this job

Paid Time Off (PTO)

Medical Insurance

Dental 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 manage the full authorization lifecycle for dermatology medications, including biologics and specialty therapies.

The ideal candidate will be highly organized, communicate effectively with patients, providers, pharmacies, and insurers, and take ownership of the process from start to finish to minimize delays in patient care.

Qualifications

• Prior authorizations, medication authorizations, or insurance verification experience.
• Dermatology experience is a plus.
• Experience with biologics is highly preferred.
• Strong understanding of health insurance terminology.
• Excellent written and verbal communication and attention to detail.

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

Skills

Prior authorizations

Medication authorizations

Health insurance processes

Communication skills

Organization

Time management

Detail-oriented

HIPAA compliance

EMR experience

Dermatology experience

Tools

EMR systems

Insurance portals

Job description

Cleaver Dermatology & Aesthetics is seeking a detail-oriented Biologics & Medication Prior Authorization Specialist to manage the full authorization lifecycle for dermatology medications, including biologics and specialty therapies.

The ideal candidate will be highly organized, communicate effectively with patients, providers, pharmacies, and insurers, and take ownership of the process from start to finish to minimize delays in patient care.