Anne Arundel Dermatology At Anne Arundel Dermatology we give exceptional care - to our patients and to eachother. Patient First | Caring | Accountability | Trust | One Team | Growth Founded 50+ years ago with a mission to provide the highest quality and full spectrum of medical, surgical, and esthetic skin care services to each and every one of its patients, Anne Arundel Dermatology has assembled the finest group of dermatologists in the Mid-Atlantic and Southeastern states. With 250+ clinicians and 110+ locations in 7 states, we're thriving, growing, and looking to add talented individuals to our team! We are committed to continual training and education for our physicians and staff. We are on top of the latest developments in dermatology including ongoing research, emerging treatments, new medications and prevention methods. You can find more than just a job with Anne Arundel Dermatology. We believe in providing our new associates with intensive hands on training and long-term career growth opportunities from within. As a Prior Authorization Specialist at our dermatology practice, you will play a critical role in ensuring that our patients receive timely and appropriate approval for medical treatments, procedures, and medications. You will be responsible for navigating the complex world of insurance authorizations, communicating with insurance providers, and collaborating with healthcare providers to streamline the authorization process. Your attention to detail and knowledge of dermatology procedures and treatments will be instrumental in ensuring the best possible care for our patients.
Responsibilities:
This position is responsible for coordinating insurance authorizations, outbound referrals, diagnostic testing, and related patient access activities. The role serves as a liaison between providers, patients, insurance companies, pharmacies, specialty pharmacies, and outside healthcare facilities to ensure ordered medications, referrals, and testing are completed as efficiently as possible.
Duties/Responsibilities:
Prior Authorizations: Manage authorization requests for medications, specialty/biologic therapies, diagnostic testing, and other provider-ordered services. Verify insurance requirements, gather clinical documentation, submit requests through appropriate platforms, and monitor pending authorizations through determination.
Denials & Appeals: Review authorization denials, identify necessary next steps, and coordinate additional documentation, resubmissions, step-therapy requirements, or appeals as appropriate.
Outbound Referrals: Coordinate referrals to outside specialists and healthcare facilities, including verifying insurance requirements, submitting supporting medical records, communicating with receiving offices, and following up on outstanding referrals.
Diagnostic Testing & Procedures: Coordinate provider-ordered imaging, laboratory testing, and other diagnostic services, including insurance authorizations, facility coordination, required documentation, and follow-up on outstanding testing and results.
Patient & Provider Communication: Serve as a point of contact for patients, providers, insurance companies, pharmacies, and outside facilities to communicate updates, resolve access issues, and address delays in care.
Insurance Research & Troubleshooting: Independently research payer requirements, formulary restrictions, specialty pharmacy requirements, and other coverage-related issues to determine appropriate next steps.
Tracking & Follow-Up: Maintain organized tracking of pending authorizations, referrals, appeals, diagnostic testing, and requests requiring additional action. Proactively follow up to ensure requests are appropriately resolved or transferred for further management.
Documentation: Maintain accurate and timely documentation of authorization details, referral information, insurance communications, and follow-up activities within the patient's medical record.
Collaboration & Escalation: Work closely with clinical and administrative teams to address outstanding requests, obtain necessary information, and escalate urgent or unresolved issues as appropriate.
Other duties assigned as deemed necessary by management.
Qualifications
Required Skills/Abilities:
Proficiency in medical terminology and knowledge of dermatology procedures.
Excellent communication skills, both written and verbal.
Strong organizational skills with attention to detail.
Ability to work independently and as part of a team.
Familiarity with insurance providers, billing systems, and authorization software is a plus.
Licensure/Certifications/Education
Education and Experience:
High school diploma or equivalent; additional education or certification in healthcare administration or related field preferred. Prior experience in prior authorization processes within a dermatology practice or healthcare setting is highly desirable.
Physical Requirements:
Prolonged periods of sitting at a desk and working on a computer. Must be able to lift 15 pounds at times.
