GENERAL SUMMARY:

Supports timely access to cardiac and cardiometabolic medications by completing prior authorizations, verifying insurance benefits, and coordinating with payers, pharmacies, specialty clinics, and manufacturer assistance programs. Reviews provider orders for completeness and payer-required criteria (such as step-therapy requirements) and communicates with providers when additional documentation is needed for approval. Coordinates infusion and injection scheduling and reinforces RN-provided patient education within the boundaries of CMA/LPN scope of practice. Requires strong working knowledge of cardiology disease states, medication therapies, and insurance coverage policies to ensure accurate and efficient medication access.

PRINCIPAL JOB FUNCTIONS:

1. *Commits to the mission, vision, beliefs and consistently demonstrates our core values.

2. *Completes prior authorization requests by gathering clinical documentation, submitting requests, and following up with payers.

3. *Reviews provider orders for completeness and payerrequired prerequisites, not for clinical appropriateness.

4. *Identifies steptherapy requirements, formulary restrictions, and coverage limitations.

5. *Communicates with providers regarding missing documentation needed for authorization.

6. *Verifies insurance benefits and explains coverage expectations to patients.

7. *Coordinates scheduling and authorization for infusion and injection therapies with the Specialty Clinic, Metro Infusion Center, and other partners.

8. *Reinforces RNprovided patient education by reviewing instructions and answering nonclinical questions.

9. *Manages enrollment and renewal processes for manufacturer assistance programs, copay support, and grant funding.

10. *Identifies financial assistance options based on insurance coverage and clinical documentation.

11. *Works closely with RNs, providers, clinic staff, pharmacies, and payers to resolve authorization issues.

12. Serves as a liaison between patients, providers, and external partners to support timely medication access.

13. *Tracks authorization status, documents all actions taken, and maintains organized records.

14. Assists with developing and refining workflows to improve efficiency and reduce delays.

15. Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise.

16. Participates in meetings, committees and department projects as assigned.

17. Performs other related projects and duties as assigned.

(Essential Job functions are marked with an asterisk “*”. Refer to the Job Description Guide for the definition of essential and non-essential job functions.) Attach Addendum for positions with slightly different roles or work-specific differences as needed.

EDUCATION AND EXPERIENCE:

Completion of an accredited Medical Assistant program with current CMA or RMA certification OR current LPN licensure in the State of Nebraska required.Minimum of two (2) years of experience in a clinical setting supporting medication management, specialty therapies, or chronic disease care required. Experience in cardiology or specialty medications strongly preferred. Experience with prior authorizations, insurance verification, or pharmacy benefit investigation preferred.