Job Description

Something special starts here.

You can’t define it, but you know it when you see it: the difference between an average life and the good life. When your cup is full – with joy, purpose and lifelong health – it shows. At LMH Health, we are all about healthy people, healthy communities and healthy futures, and that makes us your destination for an exceptional career. From flexible, work-life harmony to competitive pay and great advancement potential, find everything you’re looking for at LMH Health.

You'll find everything you’re looking for at LMH Health:

• Join a team that cares about the community
• Tuition reimbursement to support continuing education
• Professional development and recognition
• Excellent benefits

We’re looking for you.

Job Description

The Medication Prior Authorization Specialist is responsible for the coordination of insurance prior authorizations for applicable patient prescriptions. This role liaises with providers, insurance companies, and patients to perform insurance verification, obtain prior authorizations, and bring the authorization process to resolution.

ESSENTIAL JOB RESPONSIBILITIES

• Monitors prior authorization work queues WQ(s) and promptly obtains and/or reviews patient insurance information and eligibility verification required to secure medication prior authorizations.
• Utilizes online, fax, and telephony pathways to obtain prior authorizations from insurance companies for prescribed medications and documents medication prior authorizations in the medical record as necessary
• Seeks additional information and/or communicates updates to patients and providers as appropriate throughout the prior authorization process.
• Engages insurance company representatives and provides required clinical information to secure prior authorization, when necessary.
• Engages practice operations and incorporates clinical care team when prior authorization attempt is unsuccessful and/or a peer-to-peer and/or alternative medication is required.
• Escalates complex prior authorization issues to Supervisor, Medication Prior Authorization for assistance/guidance.
• Maintains working knowledge of electronic medical record system, internal systems and tools, and other online insurance websites.
• Maintains solution-oriented/creative mindset to effectively anticipate and tend to patient needs by partnering with other organizational team members/departments.
• Actively participates in performance improvement and continuous quality improvement activities.
• Other related duties as assigned.

III. JOB QUALIFICATIONS

• Required
• High School Diploma
• One year practice-based experience or in a similar healthcare setting

Our Cultural Beliefs

• People First
• Integrity Matters
• Better Together

At LMH Health, we value inclusion and diversity. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law.