Medical Assistant – Prior Authorization & Care Management

Arcturus Healthcare Plc; Troy, Northern (MI, KY); Hybrid; USD 38,000 - 47,000; Full time

Job summary

Arcturus Healthcare Plc in Troy, MI seeks a Medical Assistant – Prior Authorization & Care Management to join our team. You will apply clinical knowledge to support prior authorizations, patient care coordination, chart review, and chronic care management.

Ideal candidates combine medical terminology expertise with strong communication and organizational skills to collaborate with providers, staff, patients, and insurers for timely access to care.

Qualifications

• Medical Assistant certification preferred.
• Experience as Medical Assistant in a physician office or healthcare setting.
• Strong understanding of medical terminology, abbreviations, diagnoses, medications, procedures, and clinical documentation.
• Experience with prior authorizations, referrals, insurance companies, or care coordination preferred.
• Experience with chronic care management calls or patient outreach is a plus.
• Excellent written and verbal communication skills.
• Strong organizational skills and attention to detail.
• Ability to prioritize multiple tasks and meet deadlines.
• Proficient computer skills and experience with electronic medical records.

Responsibilities

• Complete and manage prior authorization requests for medications, testing, procedures, imaging, and other medical services.
• Review patient charts and clinical documentation to gather the information required for referrals and prior authorizations.
• Communicate with insurance companies to obtain required authorizations and resolve authorization issues.
• Work closely with providers and clinical staff to obtain necessary clinical information and supporting documentation.
• Process and coordinate patient referrals to specialists and outside healthcare providers.
• Monitor referrals and prior authorizations and follow up to ensure timely completion.
• Contact patients regarding referrals, authorizations, appointments, testing, medications, and other care coordination needs.
• Perform chronic care management and patient outreach calls as assigned.
• Assist patients with coordinating their care and understanding next steps in their treatment plan.
• Document all patient contacts, follow-up activities, referrals, and authorizations accurately in the electronic medical record (EMR).
• Utilize knowledge of medical terminology, diagnoses, medications, procedures, and treatment plans when reviewing patient charts and communicating with providers and insurance companies.
• Review medication information and assist with medication-related prior authorization requirements and patient follow-up.
• Identify missing or incomplete documentation and work with clinical staff to obtain the necessary information.
• Maintain accurate and timely records while protecting patient confidentiality and complying with HIPAA requirements.
• Provide professional, compassionate, and responsive customer service to patients.
• Assist with other Medical Assistant and clinical administrative duties as needed.

Skills

Medical terminology

Communication

Organization

EMR proficiency

Time management

Education

Medical Assistant certification preferred

Tools

EMR systems

Job description

Arcturus Healthcare is seeking a motivated and detail-oriented Medical Assistant – Prior Authorization & Care Management to join our team. This position is ideal for a Medical Assistant who enjoys using their clinical knowledge while taking on a greater role in prior authorizations, patient care coordination, chart review, and chronic care management.

The ideal candidate will have strong knowledge of medical terminology, medications, diagnoses, and clinical documentation, along with excellent communication and organizational skills. This position will work closely with providers, clinical staff, patients, and insurance companies to help ensure patients receive timely access to appropriate care and services.

Responsibilities

• Complete and manage prior authorization requests for medications, testing, procedures, imaging, and other medical services.
• Review patient charts and clinical documentation to gather the information required for referrals and prior authorizations.
• Communicate with insurance companies to obtain required authorizations and resolve authorization issues.
• Work closely with providers and clinical staff to obtain necessary clinical information and supporting documentation.
• Process and coordinate patient referrals to specialists and outside healthcare providers.
• Monitor referrals and prior authorizations and follow up to ensure timely completion.
• Contact patients regarding referrals, authorizations, appointments, testing, medications, and other care coordination needs.
• Perform chronic care management and patient outreach calls as assigned.
• Assist patients with coordinating their care and understanding next steps in their treatment plan.
• Document all patient contacts, follow-up activities, referrals, and authorizations accurately in the electronic medical record (EMR).
• Utilize knowledge of medical terminology, diagnoses, medications, procedures, and treatment plans when reviewing patient charts and communicating with providers and insurance companies.
• Review medication information and assist with medication-related prior authorization requirements and patient follow-up.
• Identify missing or incomplete documentation and work with clinical staff to obtain the necessary information.
• Maintain accurate and timely records while protecting patient confidentiality and complying with HIPAA requirements.
• Provide professional, compassionate, and responsive customer service to patients.
• Assist with other Medical Assistant and clinical administrative duties as needed.

Qualifications & Experience

• Medical Assistant certification preferred.
• Previous experience working as a Medical Assistant in a physician office or healthcare setting.
• Strong understanding of medical terminology, medical abbreviations, diagnoses, medications, procedures, and clinical documentation.
• Experience with prior authorizations, referrals, insurance companies, or care coordination preferred.
• Experience with chronic care management calls or patient outreach is a plus.
• Ability to effectively review and understand patient charts and clinical information.
• Knowledge of health insurance plans and prior authorization requirements preferred.
• Excellent written and verbal communication skills.
• Strong organizational skills and attention to detail.
• Ability to prioritize multiple tasks and meet deadlines.
• Comfortable communicating with patients, providers, pharmacies, specialists, and insurance companies.
• Proficient computer skills and experience with electronic medical records.
• Ability to work independently while also working effectively as part of a team.
• Commitment to maintaining patient confidentiality and providing excellent patient care.

Why Join Us?

This is a great opportunity for a Medical Assistant who enjoys the clinical side of healthcare but is interested in expanding into prior authorizations, care management, and patient care coordination.