Medical Assistant Prior Authorization Specialist

Texas Diabetes & Endocrinology, P.A. (TD&E) has grown over the years to meet the Endocrinology needs of the Austin community. Our mission is to strive to provide expert care in Diabetes, Thyroid problems, Osteoporosis, weight management, and hormonal conditions by providing thorough evaluations and innovative, personalized solutions focused on our patients success. Our employees are the strength that keeps us moving forward.

Our Central office is looking for a full-time Medical Assistant Prior Authorization Specialist to join the Clinical team! This position can be onsite or Remote!

The Medical Assistant (MA)-Prior Authorizations Specialist is responsible for processing prior authorizations for prescriptions following all established procedures and guidelines. This position may assist with other clinical duties.

Key Functions include but are not limited to:

• Receives and processes patient and pharmacy Prior Authorizations (PA) requests received electronically or via fax
• Answers the PA line and returns voicemails. May assist with walk-in patients.
• Communicates with insurance companies and fills out PA forms including patient diagnosis, lab results, and justification for requested medication. Works with provider to complete authorization. 
• Administers the “plan exclusions” process, seeking new prescription from provider as needed
• Communicates approvals and denials. Assists provider with the appeals process, including Letter of Medical Necessity.
• Uploads PAs and logs all interactions in the electronic medical records (EMR) system
• Provides samples and coupons to patients as authorized
• Stays up to date on insurance-approved medications and formulary changes

Additional Non-Essential Functions:

• Assists with calls on the emergency/MD line
• May assist with faxes and mail to include collecting and routing electronic and paper faxes to appropriate department folder or employee, routing provider mail noting last visit information, and scanning documents into the patient file
• May assist in administering injections
• May assist with Floor MA duties during staffing shortages
• May act as the site’s point of contact for drug sample/drug rep management to include informing drug reps of drug sample needs, coordinating delivery, and maintaining the drug medication sample closet and drug medication inventory
• May occasionally assist with moving or lifting patients up to 50 pounds
• Additional duties as assigned

Experience:

Required:

• 1 year of prior Medical Assistant experience

Preferred:

• 2+ years of prior Medical Assistant experience
• Graduate from an accredited Medical Assistant Program; Certified or Registered Medical Assistant credentials
• Prior clinical/triage support experience
• Bilingual in English and Spanish

AAP/EEO Statement

Texas Diabetes & Endocrinology, P.A. (TD&E) provides equal employment opportunities (EEO) to all employees and applicants for employment in accordance with applicable federal, state, and local laws. TD&E complies with applicable state and local laws governing nondiscrimination in employment in every location in which it has facilities.

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.