Clinical Support Specialist

2680

Remote?: 1

Highlights (Bonus, shift, relocation, info for job):

• 2+ years prior authorization experience required.

Job Summary

 

The Clinical Support Specialist is responsible for completing prior authorizations and supporting all aspects of the PA process, including documentation, expedited reviews, appeals, and cross-functional coordination. This role is accountable for meeting established KPIs (e.g., turnaround time, completion rate, approval ratio), participating in process improvement initiatives, and supporting retraining efforts during workflow transitions. The Specialist utilizes automation platforms and reporting tools to streamline operations and improve provider/patient experience.

 

Duties and 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.

 

Minimum Qualifications

 

• High School Diploma
• Pharmacy Technician or Medical Assistant.
• 2+ years prior authorization experience required.

• Experience using Electronic Medical Records preferred
• Experience with CoverMyMeds and other automation platforms preferred.
• Knowledge of payer processes and appropriate clinical documentation submission.
• Excellent interpersonal and communication skills.
• Creative, innovative, and able to independently solve problems.
• Effectively adapt and respond to a complex, fast-paced, and results-oriented environment.
• Working knowledge of Microsoft Office Suite (Word, Outlook, PowerPoint, and Excel).
• Experience in a high-volume, multi-site environment preferred.

 

Working Conditions

 

Remote role with flexibility to work from home; may be required to report to clinic or designated on-site location as operational needs arise.  You will need a dedicated, quiet workspace that is conducive to conducting telephonic outreach while adhering to HIPAA and other privacy policies. All necessary electronic supplies, including a laptop, monitors, and any other hardware or software required to perform your duties effectively, will be provided. You will be responsible for setting up and maintaining these tools in your home workspace. A reliable and high-speed Wi-Fi connection or home internet is required to perform the essential functions of this role.

 

 

Physical Requirements

 

• Ability to remain stationary for extended periods of time.
• Repetitious movements.

• Frequently move equipment or supplies weighing up to 20 lbs.

 

Direct Reports

 

None.

Why Work at AbsoluteCare?

At AbsoluteCare, we serve the most vulnerable individuals in America. These are our neighbors, people who are at higher risk for disease or who have multiple, complex, chronic illnesses. Often, they deal with an unequal healthcare system and wind up seeking basic care from emergency rooms. We take these patients out of those spaces and turn them into members: people who are entitled to some of the best, most focused care this country has to offer. 

We call this “care beyond medicine.” We have turned the doctor’s office into a comprehensive care center. Here, we surround our members with a core care team of doctors, nurses, social workers, and medical assistants who have the time and skills to get to know our members’ needs. We make the most important services available to our members under one roof. This includes a pharmacy, X-rays, a blood lab, nutrition services, urgent care, and much more.

We don’t stop at our four walls. We engage members in the communities where we all live to find the people who need us most. Through these community care teams, we remove the barriers to healthcare that so many people face daily. And it works. 

Our unique care is guided by our core values of accountability, caring, trust, and teamwork. We call it ACT².

AbsoluteCare, Inc. provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, age, disability, genetics, protected Veteran status, or any other characteristic protected by law or policy.

EEO Employer Verbiage: AbsoluteCare, Inc. provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, age, disability, genetics, protected Veteran status, or any other characteristic protected by law or policy.