RX Prior Authorization Specialist

4 weeks ago

Baltimore, Maryland, United States Johns Hopkins Medicine Full time

Since 1983, Johns Hopkins Care at Home has provided safe, high-quality and cost-effective care in the home and community. Our team links care across multiple sites for patients, families and colleagues in an effort to restore, maintain and promote health and reduce the effects of disease and disability. As part of Johns Hopkins Medicine, we have access to the most innovative treatments and latest research, and we emphasize education and training among our team members. We also collaborate with doctors, nurses and specialists throughout Johns Hopkins Medicine to ensure continuity of your care.

Click here to learn about how to elevate your possibilities as you follow one of our employees' journey from a high school graduate to Pharmacy Business Manager, and the relationships she made along the way

We are seeking a skilled Pharmacy Prior Authorization Specialist to join our team. This role, under the direct supervision of the Prior Authorization Supervisor, involves collaborating with pharmacists, medical staff, billing assistants, and external entities such as third-party payers and prescription benefit management companies.

Key Responsibilities:

  • Process and verify prescriptions for various disease states.
  • Address and resolve rejected insurance claims.
  • Conduct and complete third-party prior authorization requests.
  • Verify prescriptions for non-Hopkins entities when necessary.
  • Review patient-specific Epic Medical Charts to ensure insurance criteria are met.
  • Input prior authorization referrals into the Epic Pharmacy Tool Kit.
  • Assist the patient assistance team in securing access to necessary medications.

What Awaits You?

  • Career growth and development
  • Diverse and collaborative working environment
  • Competitive Benefits Package
  • Tuition Assistance

Minimum Qualifications:

  • High School Diploma or Equivalency
  • Registration with the Maryland Board of Pharmacy is required upon hire.
  • PTCB Certification, national certification with the Pharmacy Technician Certification Board preferred
  • One (1) year retail pharmacy technician experience preferred.
  • One (1) year in health care related billing and or retail pharmacy required, three (3) years preferred.

Important Notices:

***Effective January 1st 2022, you must be fully vaccinated with an FDA COVID-19 vaccination and provide proof of your vaccination status as part of your new employee pre-boarding. Exceptions to the COVID-19 vaccination requirement may be granted for medical reasons and religious beliefs. Requests for medical exceptions must be submitted at your occupational health screening. In the wake of the COVID-19 pandemic, the Johns Hopkins Health System remains committed to providing the highest quality care for our patients and our communities.

***Authorization to Work in the United States: Applicants who require sponsorship now or in the future will not be considered for this position.

Johns Hopkins Health System and its affiliates are drug-free workplace employers.

We are committed to providing a healthy and safe environment for our patients, visitors and staff members. The Johns Hopkins Health System has a tobacco-free at work policy. Employees must refrain from using any tobacco products during their work shifts — including while at lunch or on breaks, and whether they are on or off campus.

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