Prior Authorization Specialist (CMA or Pharm Tech)

Medical Associates; Dubuque (IA); Hybrid; USD 40,000 - 60,000; Full time

Benefits offered by this job

Health insurance

401k

Flexible Paid Time Off

FSAs (Medical and Dependent Care)

Life insurance

Job summary

Medical Associates Health Plans is seeking a CMA or Pharmacy Tech to join as a full-time Prior Authorization Specialist in Dubuque, IA. The role supports authorization workflows, communicates with payers, and collaborates with providers to obtain necessary documentation.

The position offers a standard schedule of 8:00am–5:00pm, Monday through Friday, with potential for flexible hours and the possibility to work from home after training. A competitive benefits package accompanies the role.

Qualifications

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

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.

Education

CMA certification / CCMA / RMA or Pharmacy Technician Certification Board

Job description

Medical Associates is looking for a CMA or Pharmacy Tech 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) OR have a Valid Pharmacy Technician with National Certification such as Pharmacy Technician Certification Board.

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.