CMA, Prior Authorization Specialist - Women's Health - Atlantic Health System

Overview:

We are seeking a skilled Medical Prior Authorization Specialist to join our team. The ideal candidate will be responsible for obtaining prior authorization for all obstetrical patients, medication authorizations, and medical procedure authorizations from insurance companies. This role involves coordination with various departments, reaching out to insurance providers, gathering, and providing necessary documentation, scheduling peer-to-peer reviews, and meticulously documenting the entire authorization process.

 

Responsibilities:

1. Initiate and manage the prior authorization process for all obstetrical patients and gynecological patients to include all obstetrical care with delivery, radiology services, consultation referrals, labs, medications, and medical procedures. Primary responsibility will be to enter information on the PRA/SPECT Perinatal Risk Assessment & Single Point Entry Client Tracking for the State of New Jersey.  This system will link authorizations and support services to obstetrical patients

2. Communicate effectively with internal departments and insurance companies to obtain necessary authorization 

3. Gather and organize patient medical records, treatment plans, and other relevant documentation required for authorization.

4. Ensure all documentation provided meets insurance company requirements and guidelines.

5. Collaborate with providers to obtain additional information or clarification as needed.

6. Schedule and facilitate peer-to-peer reviews between providers and insurance company medical directors.

7. Document all communication and actions taken throughout the authorization process accurately and thoroughly.

8. Monitor the progress of authorization requests and follow up as necessary to expedite approvals.

9. Stay updated on changes in insurance policies, guidelines, and procedures related to prior authorizations.

10. Provide support and guidance to providers and staff regarding prior authorization requirements and processes.

11.  Work in a CMA role with patients in various Women’s Health departments as needed for additional coverage.

12.  Provide any additional support for projects required within the departments. 

Atlantic Medical Group is a physician-led and physician-governed organization that delivers the highest quality health care, at the right place, the right price, and the right time.  We are a multispecialty physician group with more than 1,000 doctors, nurse practitioners and physician assistants at over 300 locations throughout northern and central New Jersey and northeast Pennsylvania. Our mission is to deliver exceptional care recognizing the unique needs of all those we serve. Our vision is to achieve the best outcomes with our patients at the center of the physician-led team, driven by service, innovation and continuous learning.

Our integrated network offers seamless access to Atlantic Health System’s entire health care continuum and our nationally and regionally ranked hospitals. In collaboration with Atlantic Health System, several of our practices offer urgent care and walk-in services.

In addition to primary care physicians, the team includes specialists that care for patients in all aspects of their health from pediatrics to geriatrics and everything in between. We make health decisions easier for patients with enhanced access to referrals.

EEO STATEMENT

Atlantic Health System, Inc. is an equal employment opportunity employer and federal contractor or subcontractor and therefore abides by applicable laws to protect applicants and employees from discrimination in hiring, promotion, discharge, pay, fringe benefits, job training, classification, referral, and other aspects of employment, on the basis of race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, citizenship status, disability, age, genetics, or veteran status.

Atlantic Health System is at the forefront of medicine, setting standards for quality health care powered by a workforce of more than 18,000 team members and 4,800 affiliated physicians dedicated to building healthier communities, the system offers more than 400 sites of care, including eight award-winning medical centers. Specializing in cardiovascular care, cancer care, orthopedics, neuroscience, pediatrics, women's health and rehabilitation medicine. Atlantic Medical Group, comprised of 1,000 physicians and advanced practice providers, represents one of the largest multi-specialty practices in New Jersey and includes finance, legal, marketing, human resources, talent acquisition, ISS and more. Caring for our patients, our team members and the communities we serve is our central mission.