Infusion Prior Authorization Specialist

3 weeks ago

St Louis, United States Actalent Full time

Specialist - Infusion Prior Authorizations

Job Description

Purpose: Managing patient's insurance benefits and utilizing established patient assistance programs. Develop client-based relationships with clinical staff and patients, presenting pharmacy service options through customized financial analysis, and facilitating information gathering for program enrollment (patient assistance and indigent programs).

Responsibilities

+ Liaison between the medical staff, outpatient pharmacies, insurance providers, and patients to improve communication and continuity of care.

+ Review patient information and insurance status to identify socioeconomic barriers, opportunities for intervention, and eligibility for prescription assistance.

+ Conduct prior authorization services.

+ Understand payer reimbursement and patterns for pharmacy and medical claims with third parties.

+ Serve as the primary ambulatory pharmacy resource to facilitate access to prescription and medical benefit medications, including but not limited to formulary/coverage issues, copay issues, patient assistance program eligibility, and other indigent programs.

+ Coordinate services with appropriate departments and internal patient care team members regarding patients who have limited financial resources for paying for medications and facilitate medication access to support discharge preparations.

+ Interact with hospital and clinic employees, including but not limited to pharmacists, clinical staff, fiscal personnel, department managers, access services staff, coding staff, and billing assistants. External contacts include but are not limited to third-party payers, manufacturers, prescription benefit management companies, external pharmacy personnel, and referring providers and their support staff.

Essential Skills

+ Experience in infusion prior authorization.

+ Proficiency with EPIC software, Required.

+ Knowledge of medical billing and coding.

+ Experience with infusion services.

+ Pharmacy technician license.

+ Experience in insurance verification.

Work Environment

+ Hours: Monday-Friday 8-4:30

+ 3 month contract

+ Pay: $26-30/hour

This role involves interacting with a diverse group of hospital and clinic employees, external contacts including third-party payers, and pharmacy personnel. You will work closely with the internal patient care team to support patients with limited financial resources. The position requires proficiency with EPIC software and a thorough understanding of medical billing and coding. The job environment may involve handling sensitive patient information and coordinating with various healthcare departments.

About Actalent

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.

Diversity, Equity & Inclusion

At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:

+ Hiring diverse talent

+ Maintaining an inclusive environment through persistent self-reflection

+ Building a culture of care, engagement, and recognition with clear outcomes

+ Ensuring growth opportunities for our people

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com (%20actalentaccommodation@actalentservices.com)

for other accommodation options.

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