Prior Auth/RX Refill CMA/LPN (RR-8F)
at Salem Clinic

Date Posted: 2/10/2019

Job Description

Hours: Full-time, 40 hours/week, Various hours
Location: South/Inland Shores
Department:
Nursing, RX Refill

Job Summary/Position Objective: 

Responsible for tasks/functions related to the prior authorization process and the Rx refill process. Assist in the delivery of health care by processing prior authorizations and providing the physicians with the information (per standing order) necessary to review, approve or deny refill requests.

Required Knowledge, Skills, Abilities: 

1.      Graduate of a Medical Assistant program with a nationally recognized certification such as AAMA, NCCT, or AMT. 

2.      Knowledge of medical terminology. 

3.      Skill in establishing and maintaining effective working relationships with patients, medical staff, pharmacies, and insurance companies. 

4.      Proficient written and oral communication skills with patients, providers, insurance companies and referral department. 

5.      Ability to read, understand, and respond to detailed oral and written instructions.  Ask clarifying questions as necessary.

6.      Ability to communicate with providers and other departments as needed in order to resolve denied authorizations.

7.      Using standing orders identify medical documentation in EHR needed by providers to safely approve or deny prescription refills.

8.      Document criteria for specific medication categories in Rx Request message prior to routing to the provider.

9.      Ability to be flexible and adaptable to changing assignments and work pace.

10.  Ability to recognize problems and share ideas for solutions.  Good judgment and decision making skills.

11.  Ability to utilize computer programs expected for patient care (EPIC, SC Fox), access patient information from the internet, and the ability to type at least 30 wpm.

12.  Must be a team player, have a positive attitude, and be detail oriented.

13.  Must be organized and able to manage competing priorities.

14.  Able to work independently with minimal supervision.

15.  Knowledge of common safety hazards and precautions to establish a safe work environment

Preferred Qualifications: 

1.      Current CPR certification.

2.      Experience working in a medical office setting.

3.      Experience working with Rx refills and/or prior authorization forms

Essential Functions:

1.      Responsible for initiation of all prior authorization requests.

2.      Point of contact for patients with prior authorization questions.

3.      Determine patient’s insurance and be familiar with the prior authorization requirements of each insurance company.

4.      Maintain on-going tracking of prior authorizations and ensure prior authorizations are addressed in a timely manner.

5.      Review medical documentation in EHR needed to complete prior authorization form.  Ensure that CPT codes and ICD10 codes are correct.  Identify and resolve any issues by clarifying with medical provider.

6.      At a steady pace, accurately review, gather, and document pertinent medical information needed by the provider to process an electronic refill request, a telephone refill request, and/or a faxed refill request.

Job Requirements

Other Duties: 

1.      Perform other duties as assigned.

2.      Attend required meetings and participate in committees as requested.

3.      May act as a preceptor for orientation of new staff / students.

Job Snapshot

About Us

Founded in 1925, Salem Clinic is deeply rooted in the Salem and Keizer medical communities. We have steadily grown from a three physician practice to one that includes over ninety healthcare providers and 500 staff members. Our multi-specialty group practice design benefits patients through every phase of life. Our physicians represent family medicine, internal medicine, general surgery, obstetrics and gynecology, urgent care and hospital medicine.

Our five convenient locations bring healthcare close to home for our patients. In addition to our primary care physicians and specialists, Salem Clinic also maintains a full service laboratory with a robust testing menu and an imaging department with highly skilled technologists. The Clinic’s ancillary testing capabilities include general x-ray, bone densitometry, CT, MRI, ultrasound, echocardiography, mammography, EKG, nuclear medicine and all varieties of blood, urine and other specimen collection and testing.

The large multi-specialty group practice setting enables Salem Clinic to provide patients with truly comprehensive care. We are large enough to have the resources to be on the cutting edge of technology and care models and small enough that every individual staff member can be heard and can affect change.

Salem Clinic staff and physicians are held high standards for customer service and teamwork creating a professional and friendly work environment for all to enjoy!

Are you interested in joining our team? We are looking for customer service oriented persons who enjoy working in a fast-paced, team-based, ever changing environment. We want persons who are looking for long-term employment. We reward longevity with a generous retirement benefit that includes a 10% contribution, with no matching required.

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