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    CMA (Prior Authorization)- Greenville - Eastern Nephrology Associates, PLLC

    Eastern Nephrology Associates, PLLC
    Eastern Nephrology Associates, PLLC Greenville, United States

    3 weeks ago

    Default job background
    Description
    Summary
    To obtain prior authorizations for diagnostic imaging, prescription medications, including IV therapy, medical appointment, Veterans Administration Authorizations, durable medical equipment, and specialist appointments, Position will secure authorization and notify parties in a timely manner so that patient receives the services or medications that are needed. Completion of forms for patient assistance for patients on those programs. Assist in Referral/Authorizations work que.Qualification Requirements
    Must be proficient in obtaining vital signs, recording patient information accurately and keeping the nurse manager aware of any high-risk situations.Minimum Qualifications
  • High School or equivalent
  • Completion of a medical assistant training program or education program
  • Certification (CMA, RMA, or CCMA)
  • Previous work experience in a clinic setting
  • Previous work experience in prior authorizations
    • Knowledge, Skills and Abilities
  • Knowledge of medical terminology
  • Knowledge of insurance processes
  • Knowledge of EPIC platform Computer skills using Microsoft (MS) Excel and SharePoint, MS Word, MS Outlook, MS Teams, and various data management platforms.
  • Social and Cultural Sensitivity and appropriate to ethnicity and economically diverse patient and employee base.
  • Exceptional interpersonal skills to provide excellent internal and external customer service.
  • Communicates through appropriate channels and proper use of chain of command.
  • Ability to manage emergency situations calmly and effectively.
  • Must be able to navigate electronic health records, word, and excel.
  • Be courteous and respectful to patients, care givers, staff, and providers.
  • Maintain HIPPA and adhere to organizations policy and procedures.
    • Supervisory Responsibilities
    None
  • Receive, ensure accuracy, and completion of requests for Prior Authorization through the current electronic health record (EHR) and or via phone, or fax and ensure these are properly monitored and completed to include VA authorization
  • Complete all documentation needed for the Prior Authorization process and Appeals to include referrals, submission of medical records, medical necessity documentation
  • Assist clinical in work ques
  • Other duties as assigned
    • Physical Demands
  • Hearing, visual acuity, talking.
  • Reaching, grabbing, holding – fine motor skills.
  • Extended periods in a stationary or standing position.
  • Repetitive motion such as entering data into computer-based programs.
  • Lift or move up to 10 pounds. Employees are expected to use appropriate ergonomics and tools such as hand carts for heavier loads.
    • Work Environment
    Work is normally performed in a typical interior/office work environment. The noise level is usually moderate. While performing the duties of this job, the employee is regularly required to stand and talk or hear.

    Benefits: 401(k) includes Safe Harbor and Profit Sharing / Choice of Medical Insurance Plans / Dental / Paid Disability and Life Insurance / Optional Life, Accident and Critical Insurance / Generous Paid-Time-Off

    Eastern Nephrology is the region's largest, private medical practice specializing in diseases and disorders of the kidney. Our continued growth is a direct result of providing excellent service and care to our patients. ENA is always seeking talented and compassionate clinical and administrative people to join our practice family.

    Eastern Nephrology is an equal opportunity employer. Applicants will not be discriminated against because of race, color, creed, sex, sexual orientation, gender identity or expression, age, religion, national origin, citizenship status, disability, ancestry, marital status, veteran status, medical condition, or any protected category prohibited by local, state or federal laws. We are an E-Verify Employer. Pre-employment background checks are required for all employment positions. If you are a qualified individual with a disability and are unable or limited in your ability to use or access the online application system process due to your disability, please contact the Human Resources Department at to request assistance. The company provides reasonable accommodations to qualified individuals with a disability to enable them to effectively participate in the application process, as required by law.

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