PRE-CERTIFICATION SPECIALIST
Gateway Gastroenterology
Wildwood MO 63005 US
Who We Are:
Gateway Gastroenterology is an independent 6-physician and 3-Nurse Practitioner single specialty Gastroenterology located in Chesterfield, MO.
Infusion Precertification Specialist.
Job Description:
This is a position of responsibility that supports our infusion center. The precertification specialist must verify patients' eligibility with insurance companies for infusion drug coverage. Skills include enough medical knowledge to provide the appropriate medical documentation to insurance companies in order to obtain authorization for infusion of biologic medications for Inflammatory Bowel Disease. The pre-certification specialist must also be able to monitor for expiring authorizations and be able to navigate the intricacies for the renewal process. Other responsibilities including monitoring claims payment, facilitate patient assistance payments and follow up with insurance payers as needed. Other general office duties related to patient infusions may also be included in this position.
Our Perfect Candidate
Education and Experience:
High School Diploma or equivalent required.
1-2 years of medical authorization experience preferred, but not required.
Basic computer knowledge, prior experience with eClinicalWorks a plus.
Company Offers:
Salary range that starts from $22.00/hour for those without any experience.
Benefit package includes medical, dental, and vision after 30 days. Paid holiday and vacation accrual after 30 days.
**Job Summary:**
The Gastroenterology Pharmacy Pre-Certification Specialist is responsible for managing the pre-certification and authorization process for medications used in gastroenterology treatments. This role involves collaborating with healthcare providers, insurance companies, and patients to ensure timely and accurate approval of medications. The specialist will be a key player in streamlining medication access and facilitating effective patient care.
**Key Responsibilities:**
1. **Pre-Certification and Authorization:**
- Submit pre-certification and prior authorization requests for gastroenterology medications (Remicade, Entyvio, Skyrizi) to insurance companies and third-party payers.
- Ensure all required documentation and clinical information is accurately provided to support approval requests.
- Follow up with insurance companies and healthcare providers to resolve issues and expedite approvals.
2. **Patient and Provider Support:**
- Serve as the primary point of contact for healthcare providers regarding medication authorization and pre-certification issues.
- Communicate with patients to inform them about the status of their medication authorization and any required actions.
- Provide guidance on alternative medication options or patient assistance programs if necessary.
3. **Documentation and Record Keeping:**
- Maintain accurate and up-to-date records of pre-certification requests, approvals, and rejections.
- Track and report on authorization turnaround times and any delays or issues encountered.
- Ensure compliance with all regulatory and insurance requirements related to medication pre-certification.
4. **Collaboration and Coordination:**
- Work closely with gastroenterologists, nurses, and other healthcare professionals to gather necessary clinical information for medication approval.
- Collaborate with pharmacy staff and other departments to streamline processes and improve medication access.
- Participate in interdisciplinary meetings to address complex authorization cases and develop solutions.
5. **Quality Improvement:**
- Monitor trends in medication authorization requests and identify opportunities for process improvement.
- Provide feedback and recommendations for improving pre-certification procedures and workflows.
- Stay current with changes in insurance policies, medication guidelines, and gastroenterology treatments.
**Qualifications:**
- **Experience:** Previous experience in a pharmacy pre-certification or prior authorization role, particularly in gastroenterology, is highly desirable.
- **Skills:**
- Strong understanding of gastroenterology medications and treatment protocols.
- Excellent communication and interpersonal skills, with the ability to handle complex situations with professionalism.
- Proficiency in using electronic health record (EHR) systems, eClinicalWorks preferred.
- Detail-oriented with strong organizational and problem-solving abilities.
**Physical Requirements:**
- Ability to sit and work at a computer for extended periods.
- Capable of handling multiple tasks and deadlines in a fast-paced environment.
**Work Environment:**
- Primarily office-based with occasional interactions with healthcare providers and patients.
- Collaborative setting with a focus on accuracy and efficiency.
Compensation details: 22-26 Hourly Wage
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