Preauthorization Clinical Specialist LPN/RMA/CMA in Stone

The Preauthorization Clinical Specialist is responsible for obtaining authorizations for medications prescribed by our physicians in a call center environment. This position will obtain patient information to complete insurance requirements for obtaining pre-authorization for patients’ medications.

Explore opportunities with Holston Medical Group, part of the Optum family of businesses. Holston Medical Group combines the personal feel of a community-based practice with the strength, resources and career opportunities of a leading national health care organization. As a multispecialty clinic offering care across northeast Tennessee and southwest Virginia, our teams deliver high‑quality, value‑based care that exceeds expectations while making care easier, more affordable and more accessible.

Main Responsibilities:

• Interact with patients, physicians and other staff within the offices to provide accurate, timely and responsive information.
• Obtain precertification/preauthorization from insurance companies, using an online application or by contacting insurer on the telephone.
• Ensure efficient telephone communication.
• Maintain accurate records of what insurance require authorizations and types of medications that require an authorization.
• Appropriate documentation of insurance approvals, denials and pending cases.
• Maintain strict confidentiality in all matters relating to personnel and patient PHI (Protected Health Information).
• Assist with other Call Center Activities as assigned.

Education/Experience/Knowledge:

• RMA, CMA or LPN.
• General understanding of medical terminology.
• Familiarity with computers and other office equipment.
• Must possess excellent communication and organizational skills.
• Ability to work in a team environment and collaborate with others.

Physical/Mental Demands:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Essential:

• Communication with others to exchange or express information and ideas.
• Ability to receive detailed information through oral communication, and to make fine distinctions in sounds.
• Determine the accuracy, neatness, thoroughness of the work assigned and perceive general observations.
• Remaining upright on the feet, particularly 75% of the time.
• Moving about on foot to accomplish tasks.
• Bending body downward and forward by bending spine at the waist and/or by bending leg and spine.
• Extending the hands and arms in any direction.
• Exerting force upon an object so that an object moves away/toward the force.
• Picking, pinching, typing or otherwise working, primarily with fingers.
• Applying pressure to an object with the fingers and palm.
• Perform a variety of duties, often changing from one task to another of a different nature.
• Perform with frequent interruptions and/or distractions.
• Make appropriate job decisions following standard office policies and past precedents.
• Adjust priorities quickly as circumstances dictate.
• Ability to establish and maintain cooperative working relationships with co-workers and the public.
• Ability to interact appropriately with colleagues and patients for different purposes and different context.

Marginal:

• Must be able to remain in a stationary position at least 25% of the time.
• Medium work that includes moving objects up to 50 pounds occasionally.
• Perceiving attributes of objects, such as size, shape, temperature, or texture by touching with skin, particularly that of fingertips.
• Work independently and identify potentially more effective methods of work operations.
• Observing an area that can be seen up and down or to right or left while eyes are fixed on a given point.
• Ability to identify and distinguish colours.

Disclaimer: The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. Management reserves the right to revise the job or to require that other or different tasks be performed as assigned. All job requirements are subject to possible revision to reflect changes in the position requirements or to reasonably accommodate individuals with disabilities.