Authorization and Scheduling Specialist

Job Description

Job Description

Location: ON SITE, M-F, 8am- 4pm

Paid Holidays

Paid time off

Bonuses

Health Benefits

Position Summary

The Authorization and Scheduling Specialist is responsible for obtaining and tracking insurance approval for prescribed medications and procedures ordered by providers to external facilities as applicable. This role requires strong attention to detail, excellent communication, and the ability to navigate payer, drug manufacturer, and health system portals efficiently.

Key Responsibilities

• Collaborate with other team members and communicate requirements pertaining to their patient’s insurance coverage.
• Communicate with providers, patients and their caregivers to proactively set expectations of medication approvals or denials, and scheduling procedures
• Communicate with patients and their caregivers to prepare and submit patient assistance paperwork, and ensure renewals are followed up on to prevent gaps in medication adherence and administration.
• Initiate and manage prior authorizations for prescription medications through payer portals, CoverMyMeds, fax, or phone.
• Initiate and complete scheduling for procedures ordered by providers.
• Initiated and manage prior authorizations for those procedures where the facility does not obtain their own.
• Verify insurance coverage and formulary status for new and refill medications.
• Gather clinical documentation needed for approvals (office notes, diagnosis codes, treatment rationale).
• Monitor and track all pending authorizations , follow up with payers, and update patients and providers on status.
• Document all steps and communications clearly in the EHR.
• Maintain an organized authorization log with submission dates, payer responses, and expiration dates.
• Communicate with pharmacies to resolve rejections, step therapy requirements, or tier exceptions.
• Support refills and renewals by proactively identifying upcoming expirations.
• Coordinate provider signatures or additional documentation for appeals or peer-to-peer reviews.
• Stay current with payer-specific policies for nephrology-related procedures and medications (BCBSM, Medicare/Medicaid, Optum, etc.).

Qualifications

• Previous experience in medical clerical work, insurance verification, or pre-authorization required.
• Knowledge of local health systems and communities.
• Strong attention to detail and organizational skills.
• Excellent communication skills, both verbal and written.
• Teamwork attitude.
• Great people skills and a friendly, professional demeanor
• Ability to focus and manage multiple tasks in a fast-paced environment.
• Able to handle a high volume of calls
• Proficient with computers and data entry, Microsoft Office and EMR systems

Company Description

Hypertension Nephrology Associates is a diverse, privately held practice with offices around metro Detroit. Since establishment in 1984, HNA has been providing specialized medical management of acute and chronic kidney disease, hypertension, dialysis, and post renal transplantation to patients throughout the Detroit metropolitan area.

While most services are offered in dialysis units and hospitals, HNA provides office consultation and follow-up services to patients with less critical conditions requiring a nephrology specialist. These services are provided out of our various offices in the surrounding area, including Livonia, downtown Detroit, Dearborn, Novi, Warren, and Walled Lake.

Company Description

Hypertension Nephrology Associates is a diverse, privately held practice with offices around metro Detroit. Since establishment in 1984, HNA has been providing specialized medical management of acute and chronic kidney disease, hypertension, dialysis, and post renal transplantation to patients throughout the Detroit metropolitan area.\r\n\r\nWhile most services are offered in dialysis units and hospitals, HNA provides office consultation and follow-up services to patients with less critical conditions requiring a nephrology specialist. These services are provided out of our various offices in the surrounding area, including Livonia, downtown Detroit, Dearborn, Novi, Warren, and Walled Lake.