Prescription Prior Authorization Representative

Since 1984, Waccamaw Dermatology has proudly served as the Carolinas' award-winning premier dermatology provider across our 12 welcoming locations. We're excited to invite a skilled professional to join our Wilmington team as a Full-Time dual-role Histotechnologist/ Medical Assistant. The position includes competitive compensation (based on experience) and comprehensive benefits (detailed below). We'd love to welcome you into our supportive work family where you'll find genuine opportunities for professional growth and career advancement in a positive, patient-focused environment.
Pathology Callback Representative Responsibilities:

• Assists with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed.
• Follows prior authorization workflow and policies and procedures.
• Collaborates with other departments to assist in obtaining prior authorizations.
• Reviews accuracy and completeness of information requested and ensures that all supporting documents are present.
• Receives requests for prior authorizations and ensures that they are properly and closely monitored.
• Consults with supervisor or pharmacist to obtain clearance that treatment regimen is appropriate.
• Processes referrals and submits clinical supporting documentation to insurance carriers to expedite prior authorization processes.
• Manages correspondence with insurance companies, physicians and patients as required.
• Reviews denials and submits appeals if requested by physician to get them approved from insurance companies.
• Documents all prior authorization information including approval dates, prior authorization number in patient profile.
• Proactively works on prior authorizations that are due to be expired.
• Secures patients’ demographics and medical information by using great discretion and ensuring that all procedures are in sync with HIPAA compliance and regulations.
• Maintains patient confidence and protects operations by always keeping information confidential in compliance with all HIPAA and OSHA rules and regulations.
• Contributes to team effort by accomplishing all related tasks as needed.
• Always provides superior customer service excellence.
• Remains flexible on behalf of the position and the team.
• Ability to interact both positively and professionally through multiple departments within the practice.
• Ability to work both independently as well as within a team environment.
• All other duties as assigned.

Experience Requirements:

• Medical Assistant experience or the equivalent medical background in a high-volume medical setting with the ability to read, write and interpret medical terminology, dermatology a plus.
• Ability to speak other languages a plus.
• Must have at least one year experience in prior authorization; biologics preferred, and have experience in dermatology field or another specialty.

Hours: TBD based upon department needs between the hours of 7:00am-5:30pm Monday - Friday as assigned

On-Site Presence Required at least three days per week with the option to potentially work remotely two days per week following a successful in-person training plan. 

About Us: Waccamaw Dermatology continues to build a culture where our providers and support staff share the same philosophical beliefs and are committed to providing the best clinical care and patient experience possible.  We strive to offer residents in Myrtle Beach, and across the Carolinas, the best treatment options for skin cancer and all other dermatologic conditions. Our doctors have trained at MUSC, Mayo Clinic, Johns Hopkins, Brown, Ohio State, the Royal College of Surgeons and more, yet we deliver that level of expertise in the comfort of a community dermatology practice.