Job Description

The Medical Assistant - Prior Authorization & Clinical Documentation Specialist is responsible for managing the administrative functions that support high-quality patient care. This fully remote position focuses on pharmacy prior authorizations, medical documentation, referrals, medical records, patient scheduling, and electronic health record (EHR) documentation.
The ideal candidate is highly organized, detail-oriented, and able to manage multiple priorities while meeting strict deadlines.
This individual must possess extensive experience navigating insurance requirements and be able to work independently with
minimal supervision.

Schedule: Monday through Friday, 8:00 AM to 5:00 PM PST, with a one-hour unpaid break

Essential Duties & Responsibilities

Pharmacy Prior Authorizations
• Process pharmacy prior authorizations for prescription medications in a timely and accurate manner.
• Submit supporting clinical documentation to insurance companies as required.
• Follow up on pending authorizations, denials, appeals, and renewals.
• Communicate authorization status with providers, pharmacies, insurance representatives, and patients.
• Maintain complete documentation of all authorization activities within the EHR.

Medical Documentation
• Complete Family & Medical Leave Act (FMLA), disability, return-to-work, and other leave-related paperwork accurately and within required deadlines.
• Prepare physician forms, medical necessity documentation, and additional patient paperwork.
• Ensure all documentation complies with payer requirements and HIPAA regulations.
Referrals & Medical Records
• Process and fax referrals to specialists and ancillary providers.
• Send medical records, laboratory results, imaging reports, and other requested health information.
• Track referral completion and respond to requests promptly.
Patient Care Coordination
• Schedule follow-up appointments as directed by providers.
• Communicate with patients regarding referrals, authorizations, documentation, and follow-up care.
• Document all patient interactions accurately within the electronic health record.

Administrative Support
• Maintain accurate patient records.
• Complete all back-office documentation duties in a timely manner.
• Respond promptly to provider requests and internal communications.
• Assist with additional administrative responsibilities as assigned to support efficient clinic operations.

Performance Expectations
• Complete all assigned work accurately and within established deadlines.
• Demonstrate exceptional attention to detail and organizational skills.
• Prioritize multiple tasks effectively in a fast-paced remote environment.
• Communicate professionally with patients, providers, pharmacies, insurance companies, and outside facilities.
• Maintain complete confidentiality and HIPAA compliance.
• Work independently while consistently meeting productivity and quality expectations.
• Take ownership of responsibilities and follow tasks through to completion.

Required Qualifications

• Minimum of three (3) years of recent experience processing pharmacy prior authorizations is required.

• Certified Medical Assistant (CMA/RMA or equivalent) preferred.
• Excellent working knowledge of medical terminology, insurance plans, pharmacy benefit management (PBM)
processes, and medical prior authorization requirements is required.
• Experience completing FMLA, disability, and other medical leave documentation.
• Experience working within an Electronic Health Record (EHR/EMR) system.
• Strong computer proficiency, including Microsoft Office and web-based insurance portals.
• Excellent written and verbal communication skills.
• Ability to work independently in a fully remote environment while maintaining productivity and responsiveness.

Preferred Qualifications

• Experience working in a specialty medical practice.

• Experience with insurance appeals and peer-to-peer coordination.

• Familiarity with multiple commercial insurance plans, Medicare, and Medicaid.

• Strong critical thinking and problem-solving abilities.

• Exceptional customer service skills.

Independent Contractor Perks

• Permanent work from home
• Immediate hiring
• Health Insurance Coverage for eligible locations (for full-time roles only)

Note

• Please click the "Apply" button to complete your application, including the assessment questions, technical check, and voice recording. Your hourly pay rate will be established based on your performance in the application process; submissions with all requirements fulfilled will receive priority review.