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Prior Authorization Associate information

What is the difference between Prior Authorization Associate vs Medical Billing Specialist?

AspectPrior Authorization AssociateMedical Billing Specialist
CredentialsHigh school diploma or equivalent; certification in medical billing or coding often preferredHigh school diploma or equivalent; certification in medical billing or coding often preferred
Work EnvironmentHealthcare offices, insurance companies, hospitalsHealthcare offices, billing companies, hospitals
Primary ResponsibilitiesObtain prior authorizations from insurance for procedures and treatmentsProcess and submit medical claims, handle billing and payments

The main difference is that a Prior Authorization Associate focuses on securing insurance approvals before procedures, while a Medical Billing Specialist manages the billing process after services are rendered. Both roles require similar credentials and often work in healthcare settings, but their core functions differ in the patient care and revenue cycle process.

What are the key skills and qualifications needed to thrive as a prior authorization associate?

To thrive as a Prior Authorization Associate, you need a strong understanding of medical terminology, insurance processes, and prior authorization requirements, often backed by a high school diploma or associate degree. Familiarity with healthcare management software, electronic health record (EHR) systems, and payer portals is typically required. Excellent attention to detail, organizational skills, and effective communication are essential soft skills for this role. These skills ensure timely and accurate processing of prior authorizations, minimizing delays in patient care and supporting efficient healthcare operations.

What is a prior authorization associate?

Prior Authorization Associates are professionals who handle the process of obtaining approval from insurance companies before certain medical services, procedures, or medications are provided to patients. They review clinical documentation, communicate with healthcare providers and insurers, and ensure all necessary information is submitted for timely authorization. Their work helps reduce claim denials and ensures patients receive the care they need while adhering to insurance requirements.

What are some common challenges faced by a prior authorization associate, and how can they be effectively managed?

Prior Authorization Associates often encounter challenges such as navigating complex insurance requirements, handling high volumes of authorization requests, and managing tight turnaround times. Staying organized, keeping up-to-date with payer policies, and using robust tracking systems can help manage these difficulties. Collaborating closely with clinical staff and insurance representatives is also essential for resolving issues quickly and ensuring approvals are processed efficiently. Developing strong communication and problem-solving skills is key to success in this role.
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Prior Authorization Associate jobs near you

Patient Access Liaison - KRYSTEXXA - Macon, GA - Rare Disease

Amgen, Inc.

Macon, GA • On-site

Full-time

Medical, Dental, Vision, Life, Retirement

Posted 20 days ago

Job description

Career Category
Corporate Services
Job Description
Territory Covers: Macon, Peachtree City, Savannah
HOW MIGHT YOU DEFY IMAGINATION?
At Amgen, if you feel like you're part of something bigger, it's because you are. Our shared mission-to serve patients living with serious illnesses-drives all that we do.
Since 1980, we've helped pioneer the world of biotech in our fight against the world's toughest diseases. With our focus on four therapeutic areas -Oncology, Inflammation, General Medicine, and Rare Disease- we reach millions of patients each year. Amgen is advancing a broad and deep pipeline of medicines to treat cancer, heart disease, inflammatory conditions, rare diseases, and obesity and obesity-related conditions. As a member of the Amgen team, you'll help make a lasting impact on the lives of patients as we research, manufacture, and deliver innovative medicines to help people live longer, fuller happier lives.
Our award-winning culture is collaborative, innovative, and science based. If you have a passion for challenges and the opportunities that lay within them, you'll thrive as part of the Amgen team. Join us and transform the lives of patients while transforming your career.
Live
What you will do
Let's do this. Let's change the world. In this vital role you will provide logistical, non-medical educational assistance to patients and caregivers as well as office and site of care staff, including physicians, nurses, office managers and executives. The PAL works in a highly visible, strong team environment to provide exceptional customer service on all levels. Specifically, listen to patients, interpreting their specific needs and providing friendly, professional and well-informed answers to their non-medical, logistical questions. The PAL will work with the patient to educate on next steps required to gain access to therapy. The PAL will also work to maintain relationships with patients and families, and by extension physicians and their staff and cross-functional partners to support ongoing compliance with therapy. Strong knowledge and demonstrated history of access and reimbursement for buy and bill/infused pharmaceutical products is required. The PAL will work with numerous internal teams, including Market Access, Medical Affairs, Advocacy, Marketing, and Site of Care to facilitate and improve patient access to insurance, medications, financial support, resources and more.
Key Responsibilities
  • Secure written or electronic HIPAA consent to Amgen By Your Side for patients in the assigned geography
  • Develop relationships with patients and caregivers by engaging via phone, text, email, virtual or in person connections
  • Assess individual needs of the patient and develop an appropriate education and resource plan of action, considering the patient's family and team of healthcare providers to empower the patient to become their own advocate
  • Educate the patient on KRYSTEXXA coverage based on their benefits and the steps needed to gain prior authorization to ensure understanding of the process for medication access
  • Provide information on co-pay assistance programs, national foundations, and free drug programs by sharing information to patients as appropriate and needed
  • Provide proactive education to prescribers and sites of care upon patient enrollment on coverage for Amgen rare disease therapies, common prior authorization requirements, and coding and billings requirements
  • Provide access and reimbursement education based on the enrolled patient's KRYSTEXXA benefits to physician offices and sites of care
  • Educate the physician office and/or SOC on KRYSTEXXA coverage based on the patient's benefits and the steps needed to gain prior authorization to ensure understanding of the process for medication access
  • Investigate access challenges pre and post-infusion
  • Partner with Safety and PV and report AE's and product complaints through medical information.
  • Work closely with the Amgen cross functional team including Case Managers, the Site of Care team, market access, matrix partners and external vendors
  • Adhere to professional standards compliance guidance, policies and procedures, federal, state, and local requirements

Win
What we expect of you
Basic Qualifications - Level 5
Doctorate degree
OR
Master's degree and 2 years of patient services and/or access and reimbursement experience
OR
Bachelor's degree and 4 years of patient services and/or access and reimbursement experience
OR
Associate's degree and 8 years of patient services and/or access and reimbursement experience
OR
High school diploma / GED and 10 years of patient services and/or access and reimbursement experience
Basic Qualifications - Level 6
Doctorate degree and 2 years of patient services, and/or access and reimbursement, experience
OR
Master's degree and 4 years of patient services, and/or access and reimbursement, experience
OR
Bachelor's degree and 6 years of patient services, and/or access and reimbursement, experience
Preferred Qualifications
  • Experience supporting buy-and-bill or infused pharmaceutical therapies
  • Rare disease or orphan drug experience
  • Clinical background such as nursing or allied health
  • Understanding of reimbursement processes including prior authorization, appeals, and denied claims management
  • Knowledge of HIPAA guidelines and FDA regulatory requirements
  • Familiarity with internal and OIG compliance guidelines
  • Strong analytical and problem-solving skills
  • Excellent written and verbal communication skills
  • Ability to manage complex patient situations and resolve access barriers
  • Experience working in cross-functional field teams
  • Proficiency in Microsoft Office, CRM, AI and relevant systems
  • Access and reimbursement knowledge
  • Prior authorization processes
  • Healthcare reimbursement systems
  • Coding and billing awareness
  • Patient support program knowledge
  • Compliance and privacy requirements
  • Learning agility
  • Decision quality
  • Stakeholder engagement
  • Ability to respond rapidly to urgent access needs to prevent treatment delays or lapses
  • Ability to operate effectively in matrix field environments
  • Travel up to 50%, including occasional overnight and weekend commitments

Thrive
What you can expect of us
As we work to develop treatments that take care of others, we also work to care for our teammates' professional and personal growth and well-being.
The annual base salary range is from $158,394 -$193,988 for Level 5 , $164,276 - $ 222,256 for Level 6. Actual salary will vary based on several factors including, but not limited to, relevant skills, experience, and qualifications.
In addition to the base salary, Amgen offers a Total Rewards Plan comprising health and welfare plans for staff and eligible dependents, financial plans with opportunities to save towards retirement or other goals, work/life balance, and career development opportunities including:
  • Comprehensive employee benefits package, including a Retirement and Savings Plan with generous company contributions, group medical, dental and vision coverage, life and disability insurance, and flexible spending accounts.
  • A discretionary annual bonus program, or for field sales representatives, a sales-based incentive plan
  • Stock-based long-term incentives
  • Award-winning time-off plans and bi-annual company-wide shutdowns
  • Flexible work models, including remote work arrangements, where possible

Apply now
for a career that defies imagination
Objects in your future are closer than they appear. Join us.
careers.amgen.com
Application deadline
Amgen's application deadline is August 3, 2026; we will continue accepting applications until we receive a sufficient number or select a candidate for the position.
Amgen is an Equal Opportunity employer and will consider you without regard to your race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or disability status.
We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodation.
We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodation.
Salary Range
USD - USD

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