Medication Prior Authorization Specialist

Date Posted: Nov. 19, 2021
Location: MHVI/Mercy Hospital – Mercy campus
Reports to: Clinic Supervisor
Status: Monday-Friday, 40 hours per week

SUMMARY STATEMENT:

This position is responsible for obtaining authorizations for prescribed medications. Reviews medical records and prepares clinical reviews for medical necessity and authorization. Responsible for facilitating the denial and appeal process for medications. This position will work Monday – Friday, 8 hours per day, on site at our Mercy Hospital/MHVI clinic location in Coon Rapids, MN.

MAJOR AREAS OF ACCOUNTABILITY:

• Assess clinical data from medical records to obtain authorizations.
• Abstract and submit clinical data from medical records to insurance payers.
• Utilize clinical screening criteria and reviews insurance payer medical policies to ensure patients meet medical necessity for medications.
• Assure the medical record has the proper physician clinical documentation.
• Monitor for continued authorization, communicates results and opportunities to nurses, physicians, finance, and payers.
• Evaluate potential denials or payment issues and initiates communication with physician or clinician regarding next steps.
• Prepare and facilitates appeals for denied claims.
• Facilitate peer to peer requests between the ordering physician, and the payer physician.
• Ability to keep abreast changes and efficiencies within electronic prior authorization applications.
• Other duties as assigned.

EMPLOYMENT SELECTION CRITERIA:

• Current Minnesota LPN license OR graduate of an accredited medical or nursing assistance program.
• Cardiology experience is desired, but not required.
• Flexibility to handle several duties simultaneously required.
• Strong attention to detail and high accuracy rate required.
• Ability to work varied hours.
• Must be able to travel between locations.
• Experience with electronic medical record.
• Demonstrated strengths in the following competencies:

MHVI offers a full benefit package, including:

– Competitive pay
– Uniform (scrub) allowance
– Employer HSA contribution
– 401k profit sharing and ongoing contribution – no employee contribution needed
– PTO plus paid holidays
– Medical insurance, including access to free online/at-home care 

To apply, submit your resume to HumanResources@mhvi.com

As an EEO/Affirmative Action Employer, all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, veteran or disability status.