Pharmacy Prior Authorization Specialist

4 weeks ago


Woodridge, Illinois, United States Onco360 Full time

We are seeking a highly skilled Pharmacy Prior Authorization Specialist to join our team at Onco360 Pharmacy. The ideal candidate will have excellent communication skills, be detail-oriented, and have a strong understanding of pharmacy insurance claims and prior authorization processes.

The Pharmacy Prior Authorization Specialist will be responsible for ensuring patients receive the medication they need by receiving prescriptions, addressing and rectifying rejected claims, and conducting necessary third-party authorization requests.

The successful candidate will have a strong background in pharmacy or prior authorization experience, with a good understanding of medical terminology, including sig codes and Roman numerals. They will also have excellent organizational skills, be able to work independently, and meet deadlines.

We offer a competitive salary, a comprehensive benefits package, and opportunities for professional growth and development.

Key Responsibilities:

  • Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed.
  • Follow prior authorization workflow and policies and procedures.
  • Collaborate with other departments to assist in obtaining prior authorizations.
  • Review accuracy and completeness of information requested and ensure that all supporting documents are present.
  • Receive requests for prior authorizations and ensure that they are properly and closely monitored.
  • Consult with supervisor or pharmacist to obtain clearance that treatment regimen is appropriate.
  • Process referrals and submit clinical supporting documentation to insurance carriers to expedite prior authorization processes.
  • Manage correspondence with insurance companies, physicians, and patients as required.
  • Look through denials and submit appeals if requested by physician to get them approved from insurance companies.
  • Document all prior authorization information, including approval dates and prior authorization numbers, in patient profiles.
  • Proactively work on prior authorizations that are due to be expired.
  • Secure patients' demographics and medical information by using great discretion and ensuring that all procedures are in sync with HIPAA compliance and regulation.

Requirements:

  • High School Diploma or GED.
  • Previous experience in pharmacy and prior authorization.
  • Good interpersonal skills.
  • Excellent verbal and written communication skills.
  • Ability to work independently, meet deadlines, and be flexible.
  • Good organizational skills and detail-oriented.
  • Knowledge of medical terminology, including sig codes and Roman numerals.
  • Ability to perform tasks accurately and efficiently when inputting information.
  • Licensed/registered pharmacy technician or as required by state law.
  • Basic math and analytical skills.
  • Intermediate typing/keyboarding skills.

Preferred Qualifications:

  • Associate degree or equivalent program from a 2-year program or technical school.
  • Certified Pharmacy Technician (PTCB).
  • Specialty pharmacy experience.


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