MED REFILL PRIOR AUTH SPEC

2 weeks ago

Brewer ME USA, United States Northern Light Health Full time
Northern Light Pharmacy

Department: Pharmacy - Refill-Auth Program

Position is located: Cianchette Professional Blding

Work Type: Full Time

Hours Per Week: 40.00

Work Schedule: 8:00 AM to 4:30 PM

Sign on bonus: This position is eligible for a $500 sign on bonus.

*Current employees of any Northern Light Member Organizations or those with a service break less than one year are not eligible.

Summary:

This is an entry level position. The Medication Refill and Prior Authorization Specialist is an essential member of the Northern Light Health team. The Specialist position supports a centralized service which assists with all aspects of the medication refill and prior authorization process including, utilizing the electronic medical record to process refills, processing prior authorizations, and providing call center support for the refill line for Northern Light Health practice patients across the State. Ideal candidates will have strong communication skills, ability to work independently and actively support patient-centered care with sensitivity and respect for all diversity of human experience. This is a remote, work from home, opportunity.

Responsibilities:

+ Under the supervision of the Lead Specialist, Program Manager and Director of Pharmacy the refill specialist will assist with all aspects of the medication refill process using established guidelines to facilitate authorization of medication refills for clinic patients.

+ Effectively receive prescription refills request via fax, e-prescription or phone and process requests in a timely manner utilizing the electronic health record (EHR) and in accordance with protocol and all NLH Policies and procedures.

+ Complete prior authorizations via third party applications and communicate to practice staff in an efficient and timely manner.

+ Demonstrate flexibility and teamwork by accepting changes to daily work assignments based on coverage needs and volume.

+ Escalates requests to prescriber and/or office staff when request requires extensive clinical review or denial.

+ Coordinate scheduling of visits and labs as directed by protocol, provider or the pharmacist.

+ Appropriately triage phone calls and voicemails from pharmacies, patients and providers.

+ Troubleshoot patient and provider questions and concerns, referring to Manager as appropriate.

+ Provides high quality customer service to patients, family members and care team members.

+ Signs work from home agreement and adhere to NLH's work from home policy. Understands that work from home authorization may be revoked by the Manager if conduct or productivity standards are not met.

+ May be required to work in-person from a business worksite for additional in-person training sessions or go-live events at the discretion of the Manager.

+ Other Duties as assigned

Competencies and Skills

+ Behaves with Integrity and Builds Trust: Acts consistently in line with the core values, commitments and rules of conduct. Leads by example and tells the truth. Does what they say they will, when and how they say they will, or communicates an alternate plan.

+ Cultivates Respect: Treats others fairly, embraces and values differences, and contributes to a culture of diversity, inclusion, empowerment and cooperation.

+ Demonstrates Adaptability: Learns quickly when facing a new problem or unfamiliar task; is flexible in their approach with changing priorities and ambiguity. Manages change effectively and does not give up during adversity. Capable of changing one's behavioral style and/or views in order to attain a goal. Absorbs new information readily and puts it into practice effectively.

+ Demonstrates Emotional Intelligence: Exhibits a high level of self-awareness, self-management, other awareness and relationship management. Conducts themselves in an empathic, appropriate way, with a sense of humor and stimulates a collaborative work environment. Is respectful of the attitudes, feelings, or circumstances of others and aware of the influence of their own behavior on them. Is aware of relevant social, political, system, and professional trends and developments and uses this information for the organization's benefit.

+ Effectively Communicates: Listens, speaks and writes appropriately, using clear language. Communication methods are fitting to the message(s), audience, and situation and follow-ups are regular and timely. Shows that important (non-) verbal information is absorbed and understood and asks further questions to clarify when necessary. Expresses ideas and views clearly to others and has ability to adjust use of language to the audiences' level.

+ Exercises Sound Judgment & Decision Making: Understands and processes complex information, which allows for appropriate and accountable conclusions. Does not react too quickly or slowly. Balances facts, goals, and potential approaches taking the appropriate criteria into account. Makes active decisions and commits oneself by communicating confidently and respectfully.

+ Fosters Accountability: Creates and participates in a work environment where people hold themselves and others accountable for processes, results and behaviors. Takes appropriate ownership not only of successes but also mistakes and works to correct them in a timely manner. Demonstrates understanding that we all work as a team and the quality and timeliness of work impacts everyone involved.

+ Practices Compassion: Exhibits genuine care for people and is available and ready to help; displays a deep awareness of and strong willingness to relieve the suffering of others.

+ Serves Others: Strives to understand, meet and exceed the expectations and requirements of internal and external customers which may include the people and communities in our service areas. Develops and maintains relationships, alliances and coalitions within and outside the organization and leverages them in order to obtain information, support, and promote cooperation and collaboration.

Education

+ Required High School Diploma/General Educational Development (GED)

Position Med Refill Prior Auth SpecLocation Req ID null

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