Prior Authorization Specialist (CMA)

Medical Associates; Dubuque (IA); Hybrid; USD 45,000 - 65,000; Full time

Benefits offered by this job

Health insurance

401k matching

PTO 24 days/year

FSA / Dependent Care

Life insurance

Job summary

Medical Associates is seeking a full-time CMA to join our team as a Prior Authorization Specialist. The role involves reviewing authorization requests, gathering documentation, and submitting to payers from 8:00am to 5:00pm, Monday through Friday, with potential work-from-home after training.

Location is in Dubuque, IA, with a benefits package including health insurance, 401k matching, generous PTO, FSAs, and life and disability coverage. Strong communication with providers is essential.

Qualifications

• Two or more years of medical office, referral, scheduling, insurance verification, prior authorization, or related healthcare experience preferred.
• Current certification or registration as a Certified Medical Assistant (CMA/CCMA/RMA) is required.

Responsibilities

• Review prior authorization requests and gather needed documentation from the medical record.
• Submit requests to payers, monitor status, follow up, and document outcomes.
• Collaborate with providers and clinical staff to obtain missing information for authorization.
• Communicate authorization status and payer requests to providers and staff.
• Elevate cases requiring medical necessity review or nursing judgment to the appropriate nurse.
• Complete all other assigned projects and duties.

Skills

Medical office experience

Prior authorization

Insurance verification

Healthcare experience

Education

CMA certification

CCMA certification

RMA certification

Job description

Medical Associates is looking for a CMA to join our team as a full-time Prior Authorization Specialist!

Schedule:

8:00am to 5:00pm Monday-Friday. Hours can be flexed, in coordination with other team members' schedules. Opportunity for work from home after training if desired!

Location:

Medical Associates Health Plans, 1605 Associates Drive, Dubuque, IA 52002

Full-Time Benefits Package Includes:

• Single or Family Health Insurance with discounted premium rates for wellness program participation.
• 401k with immediate matching (50% on the dollar up to 7% of pay + additional annual Profit Sharing)
• Flexible Paid Time Off Program (24 days off/year)
• Medical and Dependent Care Flex Spending Accounts
• Life insurance, Long Term Disability Coverage, Short Term Disability Coverage, Dental Insurance, etc.

Major Duties and Responsibilities:

• Review prior authorization requests and gather the supporting documentation needed from the medical record.
• Submit requests to payers, monitor status, follow up as needed, and document outcomes.
• Work with providers and clinical staff to obtain missing or additional information needed to support authorization.
• Communicate authorization status and payer requests to providers and staff.
• Recognize when a request requires clinical interpretation, medical necessity review, an appeal, or other nursing judgment and elevate those cases to the appropriate nurse.
• Complete all other assigned projects and duties.

Knowledge and Skills:

Experience: Two or more years of medical office, referral, scheduling, insurance verification, prior authorization, or related healthcare experience preferred.

Education: Equivalent to completion of a specialized course of study or certification at a business or trade school. Must possess a current certification or registration as a Certified Medical Assistant (e.g., CMA through AAMA, CCMA through NHA, or RMA through AMT).

Interpersonal Skills: A significant level of trust and diplomacy is required, in addition to normal courtesy and tact. Work involves extensive personal contact with others and/or is usually of a personal or sensitive nature. Work may involve motivating or influencing others. Ability to work independently and remain motivated in daily work is required. Outside contacts become important and fostering sound relationships with other entities (companies and/or individuals) becomes necessary.