Prior Authorization Specialist - Northwest

Gonzaba Medical Group; San Antonio (TX); On-site; USD 32,000 - 42,000; Full time

Job summary

Gonzaba Medical Group in San Antonio, TX is seeking a dedicated Medical Assistant to support the family practice department by processing prior authorization requests, reviewing medical records for justification, and coordinating with pharmacies and patients. Experience with Athena EMR and CoverMyMeds is important, along with HIPAA compliance and strong customer service.

The role involves handling in-person and telehealth communications, maintaining confidential records, and contributing to a

Qualifications

• Minimum high school education or equivalent and medical assistant certification.
• CPR certification with AED current is required.
• National CMA/RMA/NRCMA certification is preferred/required for continued employment.

Responsibilities

• Process prior authorization requests for medications and DME.
• Handle walk-in and telephonic refill requests and provide updates on prior authorizations.
• Collaborate with Medication Adherence Team to improve adherence metrics.
• Manage the Prior Authorization schedule for requests and renewals.
• Call patients regarding results or changes in medication per provider guidance.

Skills

Prior Authorization

Customer service

Communication

HIPAA compliance

Education

High school diploma

Medical Assistant Certification

Tools

Athena EMR

CoverMyMeds

RightFax

Job description

Job Details

Job Location: Northwest - 7219 Culebra Rd - San Antonio, TX 78251

Position Type: Full Time

Job Category: Family Practice

General Summary: Provides support to the family practice department by processing all medication Prior Authorization requests. Utilizes Athena and Cover My Med Portal to process prior authorizations. Reviews medical record documentation in order to obtain medical justification for new medications and or DME prescribed by the providers. Communicates with pharmacies and patients as needed.

Supervisory Responsibilities

This position has no supervisory responsibilities.

General Requirements

All duties performed will be done accurately and in a timely manner.

Responsibilities

• Assumes responsibility for maintaining clinical competencies according to Gonzaba Medical Group policy.
• Ensures customer service is always maintained at the highest level.
• Exercise tact and courtesy when dealing with patients, visitors, providers, and co-workers.
• Must always adhere to customer service expectations including in-person and virtual (via telephone, or telehealth applications) communication.
• Participates in educational programs as needed.
• Provides leadership, direction, and support to medical assistants' and LVNs' on the issues of outpatient care, medications, or scheduling.
• Assist different teams as necessary including performing the duties of other personnel as needed.
• Maintain strict confidentiality by adhering to all HIPAA rules and regulations.
• Other duties as assigned.

Essential Job Responsibilities

• Collaborates with patients, pharmacies, insurance providers, the CoverMyMeds portal, and pod staff to facilitate the processing of prior authorization requests. Additionally, handles the access and processing of Right Fax Prior Authorization requests.
• Handle walk-in patients' and telephonic refill requests and provide assistance to those seeking updates on prior authorization requests.
• Collaborate with Medication Adherence Team to help improve medication adherence metrics.
• Manage Prior Authorization schedule for prior authorization or refill needs.
• Phone patients as needed regarding results, changes in medication, dosage, and other information provided by the provider.

Work Environment

Clinic environment. Exposure to communicable diseases, bodily fluids, toxic substances, ionizing radiation, medicinal preparations, and other conditions common to a clinic environment.

Mental / Physical Requirements

Requires manual dexterity, sitting, standing, stooping, reaching, kneeling, crouching, bending, walking, lifting up to 40 lbs. without assistance. Close vision and ability to adjust focus. Must be able to work efficiently under pressure.

Additional Information

Gonzaba Medical Group is seeking team members who contribute as A-Players, demonstrate a strong work ethic, are committed to the culture and our core values.

Qualifications

Education and Training

Minimum high school education or equivalent. Applicants must hold a certificate from an accredited medical assistant school or possess equivalent medical training. CPR certification with AED is required and must be kept current. National certification as a Registered or Certified Medical Assistant is required as initial and continued employment at Gonzaba Medical Group is contingent upon this credential.

National Certification

National Certification must be issued from one of the following associations: AAMA - Certified Medical Assistant (CMA); ARMA - Registered Medical Assistant (RMA); NAHP - Nationally Registered Certified Medical Assistant (NRCMA); or other association approved by GMG Human Resources.

Experience

Experience in a clinic, doctor’s office or hospital with a minimum of one-year experience preferred.

Other Requirements

Computer Skills: Skilled in use of computer/EMR systems. Knowledge of Word processing software, spreadsheet software, Internet, and database software.