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Prior Authorization Coordinator for Medication Management

2 months ago

Allentown, Pennsylvania, United States St. Luke's University Health Network Full time


At St. Luke's University Health Network, we take pride in the dedication, expertise, and empathy of our workforce. Our employees are our greatest asset, committed to fulfilling our mission of providing exceptional care to those in need, educating healthcare professionals, and enhancing access to medical services in our communities, irrespective of patients' financial situations.

The Prior Authorization Coordinator is tasked with managing the insurance prior authorization process for patient prescriptions. This position serves as a vital link between healthcare providers, insurance entities, and patients to ensure the verification of insurance, acquisition of prior authorizations, and resolution of authorization challenges.

We are specifically looking for candidates residing in Pennsylvania and New Jersey, particularly those near St. Luke's University Health Network facilities.

KEY RESPONSIBILITIES:

  • Oversees prior authorization work queues and efficiently gathers and reviews patient insurance details and eligibility needed for medication prior authorizations.
  • Employs various communication methods, including online platforms, fax, and phone, to secure prior authorizations from insurance providers and accurately documents these in the medical records as required.
  • Proactively seeks additional information and communicates updates to patients and healthcare providers throughout the authorization process.
  • Interacts with insurance representatives and provides necessary clinical data to facilitate prior authorization when needed.
  • Collaborates with practice operations and the clinical care team when prior authorization attempts are unsuccessful or when alternative medications are necessary.
  • Escalates complex authorization issues to the Supervisor for further assistance and guidance.
  • Maintains proficiency in St. Luke's electronic medical record system, internal tools, and various online insurance platforms.
  • Adopts a solution-oriented mindset to effectively anticipate and address patient needs by working alongside other team members and departments.
  • Actively engages in performance improvement initiatives and continuous quality enhancement activities.
  • Performs other related tasks as assigned.

PHYSICAL AND SENSORY REQUIREMENTS:

Ability to sit for extended periods, typically up to 8 hours daily, with breaks as needed. Frequent use of hands for typing, phone communication, and data entry. Occasional twisting and turning motions. Capable of lifting and carrying items weighing up to 15 pounds. Ability to stoop, bend, and reach overhead to access files. Adequate hearing for normal conversations and visual acuity for reading and reviewing documents.

EDUCATION:

  • High School diploma or equivalent.

TRAINING AND EXPERIENCE:

Required:

  • Minimum of one year of experience in a healthcare setting or similar environment.

Preferred:

  • Experience in customer service roles.
  • Prior experience with insurance authorizations.
  • Background as a Medical Assistant.

We encourage you to complete your application using your full legal name and current home address, including your employment history for the past seven years. Additionally, you are invited to upload a current resume detailing your work history, education, and any relevant certifications or licenses. Creating a profile at the end of your first application submission is highly recommended. Thank you for considering a career with St. Luke's.



St. Luke's University Health Network is an Equal Opportunity Employer.