Medication Prior Authorization Specialist

4 weeks ago

Elm Grove, Wisconsin, United States Advocate Aurora Health Full time
Department:

38407 System Pharmacy - Medication Preservices

Status:

Full time

Benefits Eligible:

Yes

Hours Per Week:

40

Schedule Details/Additional Information:

Mon - Fri from 8:30 to 5pm

Position is 100% remote

Pharmacy tech experience is preferred

Major Responsibilities:
  • Ability to complete insurance verification and eligibility checks.
  • Ability to collect and accurately document initial pre-certification/authorization information if available. Initiates the process for obtaining a required referral/authorization if not obtained.
  • Ability to work assigned Epic work queue, following the department's workflow process on appropriately transferring, deferring, or removing orders from the work queue.
  • Ability to proactively communicate issues involving customer service and process improvement opportunities to management.
  • Maintains excellent public relations with patients, patient's families and clinical staff as well as demonstrates a willingness and ability to work collaboratively with others for concise and timely flow of information.
  • Maintains knowledge of and reference materials for Medicare, Medicaid and third-party payer requirements guidelines and policies, insurance plans requiring pre-authorization/referral and a list of current accepted insurance plans.
  • Ability to update the patient, physician's office, and any necessary parties, through multiple methods as appropriate (including telephone, in-basket messaging, and electronic medical record), regarding responses and outcomes of the prior authorizations.
  • Ability to act as a liaison between physician's office, patient, and pharmacy benefit manager to initiate and resolve appeals, as needed.
Licensure, Registration, and/or Certification Required:
  • None Required.
Education Required:
  • High School Graduate.
Experience Required:
  • Typically requires 1 year of experience in health care, insurance industry, pharmacy, or medical background.
Knowledge, Skills & Abilities Required:
  • Demonstrated ability to identify and understand issues and problems. Examines data and draws logical conclusions based on information available.
  • Knowledge and ability to articulate explanations of Medicare/HIPAA/EMTALA rules and regulations and comply with updates on insurance pre-certification requirements.
  • Mathematical aptitude, effective communication skills and critical thinking skills.
  • Understanding of basic human anatomy, medical terminology and procedures for application in the patient referral/pre certification/authorization processes.
  • Ability to speak effectively to customers or employees of the organization, maintaining a pleasant, professional demeanor.
  • Ability to handle sensitive and confidential information according to internal policies.
  • Ability to problem solve in a high profile and high stress area, working independently to set and meet deadlines and prioritize work.
  • Demonstrated technical proficiency including experience with insurance verification/eligibility tools, Epic electronic medical record, patient liability estimation tools, Microsoft Office, Internet Explorer and phone technology.
Physical Requirements and Working Conditions:
  • Must be able to sit majority of the workday
  • Occasionally lifts up to 10 lbs.
  • Operates all equipment necessary to perform the job.
This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

Pay Range
$21.45 - $32.20

Our Commitment to You:

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more - so you can live fully at and away from work, including:

Compensation
  • Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
  • Premium pay such as shift, on call, and more based on a teammate's job
  • Incentive pay for select positions
  • Opportunity for annual increases based on performance
Benefits and more
  • Paid Time Off programs
  • Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
  • Flexible Spending Accounts for eligible health care and dependent care expenses
  • Family benefits such as adoption assistance and paid parental leave
  • Defined contribution retirement plans with employer match and other financial wellness programs
  • Educational Assistance Program
About Advocate Health

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation's largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.

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