Treatment and Authorization Representative Wilmington

Waccamaw Dermatology; Wilmington (NC); Hybrid; USD 42,000 - 62,000; Full time

Benefits offered by this job

One day work from home

Job summary

Waccamaw Dermatology seeks a Treatment & Authorization Representative to communicate pathology results, educate patients on treatment plans, and coordinate follow-up care while obtaining insurance authorizations for prescribed medications and treatments.

This role collaborates with providers, patients, pharmacies, and insurers to ensure timely access to treatment and maintain accurate clinical documentation with compassionate patient care.

Qualifications

• Medical Assistant certification or equivalent clinical experience.
• Dermatology experience strongly preferred.
• Prior authorization experience preferred; biologics experience is a plus.
• Strong understanding of medical terminology.
• Excellent communication, organization, and customer service skills.
• Ability to multitask and prioritize in a fast-paced environment.
• Experience with EMR systems and Microsoft Office applications.

Responsibilities

• Contact patients with pathology test results and communicate findings with professionalism.
• Explain provider-recommended treatment plans and answer questions.
• Schedule procedures, surgeries, follow-ups, or additional treatment as directed.
• Provide education regarding medications, procedures, and next steps in the treatment plan.
• Document all patient interactions accurately in the EMR.
• Process prescription prior authorizations for medications, including biologics.
• Submit clinical documentation to insurance carriers and monitor authorizations.
• Maintain accurate authorization documentation and renewal dates.
• Serve as liaison between patients, providers, pharmacies, and insurers.

Skills

Communication

Customer service

Organization

Multitasking

Dermatology terminology

Education

Medical Assistant certification or equivalent

Dermatology experience

Tools

EMR systems

Microsoft Office

Job description

Job Summary

The Treatment & Authorization Representative serves as the primary point of contact for patients following diagnosis by communicating pathology results, educating patients on provider-recommended treatment plans, coordinating follow-up care, and obtaining insurance authorizations for prescribed medications and treatments. This position works closely with providers, patients, pharmacies, and insurance carriers to ensure timely access to treatment while delivering compassionate patient care, exceptional customer service, and accurate clinical documentation.

Primary Responsibilities

Patient Treatment Communication

• Contact patients with pathology test results and communicate both normal and abnormal findings with professionalism and compassion.
• Explain provider-recommended treatment plans and answer patient questions within scope.
• Schedule procedures, surgeries, follow-up appointments, or additional treatment as directed by providers.
• Provide education regarding medications, procedures, and next steps in the patient's treatment plan.
• Document all patient interactions accurately in the electronic medical record (EMR).

Prior Authorizations & Insurance

• Process prescription prior authorizations for medications, including biologic therapies and specialty medications.
• Submit clinical documentation and medical necessity information to insurance carriers.
• Monitor authorization requests and follow up to ensure timely approvals.
• Review denials and complete appeals as requested by providers.
• Maintain accurate authorization documentation, approval dates, expiration dates, and authorization numbers.
• Proactively renew authorizations to prevent interruptions in patient treatment.

Patient Care & Collaboration

• Serve as a liaison between patients, providers, pharmacies, and insurance companies.
• Maintain knowledge of dermatology treatments, pathology terminology, and insurance authorization requirements.
• Communicate professionally with internal departments to coordinate patient care.
• Deliver outstanding customer service while maintaining empathy and professionalism during sensitive conversations.
• Ensure compliance with HIPAA, OSHA, and organizational policies.
• Perform other duties as assigned.

Qualifications

Education & Experience

• Medical Assistant certification or equivalent clinical experience preferred.
• Dermatology experience strongly preferred.
• Prior authorization experience preferred; biologics experience is a plus.
• Strong understanding of medical terminology.
• Excellent communication, organization, and customer service skills.
• Ability to multitask and prioritize in a fast-paced environment.
• Experience with EMR systems and Microsoft Office applications.

Working Hours

Monday- Thursday (or) Tuesday- Friday: 8:00 - 5:00

• Hire will be working five days a week with *one day working from home