MA / LPN - Remote Prior Authorizations
You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.
Job Summary
Our client is seeking a skilled Prior Authorization Nurse to assist with medication prior authorizations. The primary responsibilities include gathering and submitting clinical documentation, investigating coverage, tracking requests, handling denials/appeals, and coordinating with healthcare professionals to expedite approvals.
Key Responsibilities
- Submitting Documentation: Gather clinical notes, lab results, and patient info, then fill out and submit PA forms to insurance companies, using electronic portals.
- Investigating Coverage: Determine which treatments require authorization, check the insurer's specific requirements, and verify patient eligibility.
- Tracking and Follow-Up: Actively monitor the status of submitted requests, responding to requests for additional information within designated timeframes.
- Handling Denials/Appeals: Initiate the appeal process for denied medications, which may involve gathering additional supporting documentation from the physician.
- Coordination: Communicate with pharmacists, prescribing physicians, and patients to resolve issues and expedite approval.
Qualifications
- Must have one of the following: CMA from the AAMA, Active LPN license, or MA Diploma from an accredited program verified by the CAAHEP or ABHES.
- 1 year of EPIC experience.
- 1 or more years working on prior authorizations.
Preferred Skills
- 2+ years of prior authorization experience.
- Experience working in a fast-paced setting.
- Experience with GLP1 prior authorization.
Schedule/Shift
Monday to Friday, 8 AM to 5 PM CST. Must be located in CST time zone.
Benefits
- Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
- Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
- 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
- Short Term Disability Insurance.
- Term Life Insurance Plan.
The role is remote and offers the convenience of working from home.
Required Employment / Compliance Language
In accordance with federal and state disability laws, Medix will be available to discuss any necessary reasonable adjustments required to enable participation in this process.
* We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).
Medix Overview:
With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we're dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.
Any required state or Joint Commission training is compensated at the state or local minimum wage rate.
* As a job position within our Allied division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: providing direct patient care, accessing medical and confidential records, accessing and administering prescription medication or other drugs, working within a clinical setting, handling sharp instruments, conducting medical procedures, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.
