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Centralized Medication
2 months ago
Must have experience doing prior authorizations
Certified Medical Assistant or Pharmacy Technician experience preferred
Supervisor:
Job Description: The prior authorization specialist is responsible for coordinating all aspects of the medication prior authorization process, including insurance verification, gathering necessary clinical information from the electronic medical record, and timely communication with patients, prescribers, and physician office staff. Candidates should possess knowledge of medical terminology as well as strong communication, interpersonal, and problem solving skills. This person should be able to interact and communicate effectively with internal and external customers, physician office staff, all members of the organization and external pharmacy and insurance members as needed.
Qualifications: High School Degree or GED. Pharmacy Technician or Certified Medical Assistant with 2-3 years clinical experience, primary care or pharmacy setting preferred but not mandatory. Prior EMR experience with eClinicalWorks and/or prior authorizations desirable. Must possess strong keyboarding skills as well as EMR and computer literacy.
General Duties:
1) Research and investigate Prior Authorization (PA) requirements by insurance company
2) Obtain Prior Authorization status updates from the insurance company and communicate to patient, pharmacy, or physician's office as necessary
3) Submit Prior Authorization application forms and all required supporting documentation to the insurance company
4) Review medical record to obtain necessary patient demographic and clinical information and seek timely clarification from pharmacist or physician as necessary
5) Review Prior Authorization denials and communicate reasons for denial to physicians and patients
6) Serve as a subject matter expert for drug formularies and the prior authorization process in general
7) Follows up with insurance companies in a timely manner regarding Prior Authorizations
8) Provides excellent customer service as evidenced by a willingness and ability to assist customers (both internal and external) with their questions/concerns, treating customers in a friendly and helpful manner, and maintaining a positive attitude.
Job Type: Full-time
Pay: $18.50 - $24.00 per hour
Benefits:
401(k)
Dental insurance
Employee assistance program
Employee discount
Flexible spending account
Health insurance
Life insurance
Paid time off
Vision insurance
Schedule:
Monday to Friday
Experience:
ICD-10: 1 year (Preferred)
Work Location: In person
