Prior Authorization Specialist

At MEDvidi, we are revolutionizing mental health care by making it more accessible and affordable across the United States. Our mission is to eliminate barriers to mental health support, ensuring that everyone can access the care they need.

As a Prior Authorization Specialist within our company, you will play a crucial role in completing the Prior Authorization requests. Your primary responsibilities will include the completion of daily tasks, resolving issues, and managing projects assigned by your lead or Manager. Your leadership skills and expertise in prior authorization operations will contribute to the overall efficiency and success of the team.

The goal is to achieve excellent performance that will bring sustainable business growth.

Requirements:

• Experience working in a healthcare setting, pharmacy, or with medical insurance.
• Working knowledge of HIPAA rules and regulations.
• Familiarity with insurance plans, coverage, and benefits.
• Understanding of diagnoses, and medications.
• Experience with electronic health records and cover my meds.
• Ability to speak with providers, insurance companies, and pharmacies professionally.
  
  

Responsibilities:

• Submit, track, and follow up on prior authorization requests for medications.
• Ensure all requests meet insurance requirements before submission.
• Request necessary documentation from providers (chart notes, prescriptions).
• Coordinate with pharmacies and providers to ensure prior authorizations are processed in a timely manner.
• Submit PA requests via cover my meds, fax, or phone.
• Provide supporting clinical notes as required to the insurance company.
• Follow up on pending request to prevent delays
• Review denial reasons and gather additional documentation.
• Resubmit or appeal requests when appropriate.
• Document all interactions, requests, approvals, and denials in the(CRM)
• Update patients on PA status when needed.
• Educate patients about expected timelines, insurance requirements, and alternative options if coverage is denied.
• Follow HIPAA guidelines to protect patient information.
  
  

Creating a diverse and inclusive workplace is one of MEDvidi's core values. We are an equal opportunity employer and welcome people of different backgrounds, experiences, abilities and perspectives.

If you have a relevant skill set and want to start your career with the fast-growing development team, this is for you. Please visit our website at www.medvidi.com for information about our services. If interested in joining our team, please email or apply to the position.

We hope to hear from you soon!