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AbsoluteCare · 10 hours ago

Clinical Support Specialist

United States

Full-time

Onsite

Entry, Mid Level

2+ years exp

AbsoluteCare is a company focused on providing comprehensive healthcare solutions, and they are seeking a Clinical Support Specialist. This role is responsible for completing prior authorizations and supporting the PA process, ensuring compliance with KPIs and improving the provider/patient experience through automation and collaboration.

Health CarePersonal HealthTherapeutics

Responsibilities

Complete prior authorization requests promptly and accurately, ensuring compliance with established KPIs (turnaround time, completion rate, approval ratio, documentation accuracy, error rate, staff productivity, automation utilization)

Accurately enter and track PA data in designated systems to support KPI monitoring and reporting

Document all account activity and respond to inquiries in a timely manner

Identify, analyze, and escalate trends or issues resulting in denials and delays; participate in root cause analysis and implement new procedures to improve effectiveness

Collaborate with pharmacy operations, clinical teams, and external partners to resolve PA issues and share best practices

Support retraining efforts for clinic and pharmacy staff during workflow transitions

Maintain extensive working knowledge of insurance companies, billing authorization requirements, and payer processes

Communicate with members, prescribers, pharmacy teams, insurance companies, and referring physicians to resolve coverage issues and expedite approvals

Utilize automation platforms (e.g., CoverMyMeds) and provider portals to streamline PA processing and improve efficiency

Demonstrate strong people skills, build effective working relationships, and contribute to a positive team environment

Exhibit strong time management and organizational skills to prioritize and meet deadlines

Apply critical thinking and independent decision-making to support the authorization process

Uphold HIPAA standards and maintain the security and privacy of all information owned by AbsoluteCare or maintained on behalf of members, employees, and business partners

Management may assign or reassign duties at any time; the job description is subject to change

Qualification

Prior authorization experiencePayer processesCoverMyMedsElectronic Medical RecordsMicrosoft Office SuiteInterpersonal skillsTime managementCritical thinkingProblem-solving