Medical Assistant – Prior Authorization - Full Time

Position Summary

Boone Memorial Health is seeking a detail-oriented and organized Medical Assistant (MA) – Prior Authorization to coordinate prescription medication refill requests and insurance prior authorizations in a timely and accurate manner. This position works closely with providers, Medical Assistants, pharmacies, patients, and insurance companies to ensure medication requests are processed in accordance with clinic policies, provider instructions, and insurance requirements.

The MA – Prior Authorization serves as an important liaison between patients, pharmacies, insurance companies, and the clinical team. The position requires strong communication, organizational, and follow-up skills, along with a commitment to maintaining patient confidentiality and complying with HIPAA and all applicable organizational policies and regulations.

Essential Functions

Reasonable accommodations may be made to enable individuals with disabilities to perform these essential functions.

Medication Refills

• Receive, review, and process medication refill requests received through telephone calls, pharmacy requests, electronic messages, and other approved methods.
• Review medication lists, allergies, last office visits, upcoming appointments, and available clinical information before forwarding refill requests to the appropriate provider.
• Process refill requests according to established clinic protocols and provider instructions.
• Route refill requests to the appropriate provider for approval when required.
• Identify medications requiring an office visit, laboratory monitoring, or other clinical follow-up before a refill can be authorized.
• Contact patients regarding refill issues, required appointments, laboratory testing, or additional information needed to process requests.
• Communicate with pharmacies regarding prescription clarification, quantities, directions, and other nonclinical issues.
• Follow up on pending refill requests to help prevent unnecessary delays in patient care.
• Accurately document all refill-related communications and actions in the electronic health record (EHR).
• Monitor refill requests to ensure completion within established turnaround times.
• Notify appropriate clinical staff or providers of urgent medication-related concerns.
• Obtain and provide Board of Pharmacy reports to the provider when requesting controlled substances.

Prior Authorizations

• Receive and process medication prior authorization requests from pharmacies, insurance companies, patients, and providers.
• Review insurance requirements and identify the information needed to complete prior authorization requests.
• Gather required clinical information from patient medical records and provider documentation.
• Complete and submit prior authorization requests through insurance portals, electronic systems, fax, or telephone, as appropriate.
• Communicate with insurance companies regarding authorization requirements and request status.
• Follow up on pending authorizations and document updates in the EHR.
• Notify providers when additional clinical information, documentation, or alternative medications are required.
• Communicate authorization decisions to appropriate clinical staff and patients.
• Assist with appeals, additional documentation, and patient assistance programs as requested by the provider or insurance company.
• Maintain an organized tracking system for pending, approved, denied, and appealed authorizations.
• Monitor authorization expiration dates and assist with renewal requests as appropriate.
• Ensure all authorization correspondence, approvals, denials, and follow-up activities are appropriately documented.
• Perform other duties as assigned by the Clinic Manager or Clinical Supervisor.

Education and Experience

• High school diploma or equivalent required.
• Current Medical Assistant (MA) certification required.
• Previous healthcare, medical office, pharmacy, insurance, or prior authorization experience preferred.
• Knowledge of medical terminology and prescription medications preferred.
• Experience working with an electronic health record preferred.
• Ability to learn and use insurance portals and electronic authorization systems.
• Strong organizational, time-management, and problem-solving skills.
• Excellent attention to detail.
• Strong written and verbal communication skills.
• Ability to communicate professionally with patients, providers, pharmacies, and insurance representatives.
• Ability to prioritize multiple requests and meet established deadlines.
• Ability to work independently while functioning effectively as part of a clinical team.
• Ability to maintain patient confidentiality and handle sensitive information appropriately.

Licensure and Certification Requirements

• Current Medical Assistant (MA) certification through a nationally recognized credentialing organization is required.
• Certification must remain active and in good standing throughout employment.
• Employees must maintain all continuing education and renewal requirements associated with their certification.
• Current Basic Life Support (BLS) certification preferred, if applicable to assigned duties.

Physical Demands

• Ability to sit and work at a computer for extended periods.
• Ability to communicate by telephone and electronic communication throughout the workday.
• Ability to maintain accuracy and attention to detail while managing multiple tasks.
• Ability to work effectively in a fast-paced medical office environment.
• Ability to maintain professional conduct and confidentiality at all times.

Working Conditions

Work is primarily performed in a medical clinic and office environment, with frequent computer, telephone, and electronic health record use. The position requires managing multiple priorities and interruptions while maintaining accuracy, confidentiality, and compliance with HIPAA. Occasional exposure to communicable illnesses and other hazards associated with a healthcare setting may occur.

Supervisory Responsibilities

None.

Travel Requirements

None.

Compliance and Patient Safety

Employees are responsible for supporting a culture of patient safety, quality improvement, and organizational compliance. Employees must follow established policies, procedures, and safety practices designed to protect patients, visitors, and staff. Safety concerns, near misses, and adverse events must be reported in accordance with organizational reporting procedures. Employees are expected to participate in patient safety and quality improvement initiatives as appropriate to their roles.

Employees must maintain a safe work environment by adhering to Boone Memorial Health's Workplace Violence Prevention Program, including promptly reporting threats, incidents, or other safety concerns.

All employees must comply with applicable federal and state laws and regulations, accreditation standards, and Boone Memorial Health policies and procedures, including requirements related to patient rights, confidentiality, and privacy.

Equal Employment Opportunity Statement

Boone Memorial Health provides equal employment opportunities to all employees and applicants for employment. Discrimination, harassment, prejudice, or other prohibited conduct based on race, color, religion, age, sex (including pregnancy), national origin, disability status, family medical history or genetic information, past or present military service, sexual orientation, gender identity or expression, family or parental status, political affiliation, or any other characteristic protected by applicable federal, state, or local law is prohibited.