Pharmacy Insurance Authorization Specialist
2 weeks ago
The University of Iowa's Department of Pharmaceutical Care is looking for a dedicated Pharmacy Insurance Authorization Specialist to become a vital part of our team. This full-time role is essential in assisting patients to secure insurance coverage for their outpatient pharmacy medications. The primary responsibilities include conducting benefits investigations, offering prior authorization assistance, and exploring financial aid options for patients, such as copay support and grant programs.
Key Responsibilities:
- Patient Revenue Management:
- Support patients and staff in benefits investigation and enrollment into pharmacy services.
- Engage with patients, pharmacists, and providers to collect necessary demographic information.
- Initiate and manage prior authorization requests, including both pharmacy and medical authorizations.
- Assist clinical pharmacy specialists or other healthcare providers in initiating appeals when necessary.
- Facilitate copay and coinsurance assistance as applicable.
- Communication and Coordination:
- Interact with patients, insurance providers, and collections to resolve payment inquiries and pre-authorizations.
- Address claim payment issues and denials using available resources.
- Document all activities accurately as required by regulatory agencies and administration.
- Operational Excellence:
- Utilize tools and processes to enhance the efficiency of the revenue cycle.
- Identify and resolve pharmacy billing discrepancies and trends.
- Propose improvements to the billing and prior authorization processes.
- Ensure compliance with cash handling policies and procedures.
- Reporting and Analysis:
- Prepare routine reports to identify trends and support financial decision-making.
- Compile information for audits from compliance and insurance payors.
- Document activities required by regulatory agencies and administration.
- Training and Development:
- Communicate effectively with providers, payors, and colleagues to resolve revenue cycle challenges.
- Participate in the orientation of pharmacy staff on billing practices.
Qualifications:
- Education: A Bachelor's degree or an equivalent combination of education and experience is required.
- Certification: Successful completion of the pharmacy technician certification exam within twelve months of employment.
Experience:
- Prior experience in customer service is essential.
- Proficiency in computer software applications, including Microsoft Office Suite.
- Strong attention to detail and ability to maintain accurate records.
- Effective verbal and written communication skills.
- Familiarity with medical terminology is preferred.
This position offers a unique opportunity to contribute to patient care and the efficiency of pharmacy services within a collaborative environment. We encourage qualified candidates to consider this role as a significant step in their professional journey.
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