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Prior Authorization Coordinator

4 weeks ago

Allentown, Pennsylvania, United States St. Luke's Hospital Full time
Job Summary:

The Medication Prior Authorization Specialist at St. Luke's Hospital plays a vital role in ensuring seamless patient care. This position is responsible for coordinating insurance prior authorizations for applicable patient prescriptions, liaising with providers, insurance companies, and patients to perform insurance verification, obtain prior authorizations, and bring the authorization process to resolution.

Key Responsibilities:
  • Monitor prior authorization work queues and promptly obtain and/or review patient insurance information and eligibility verification required to secure medication prior authorizations.
  • Utilize online, fax, and telephony pathways to obtain prior authorizations from insurance companies for prescribed medications and document medication prior authorizations in the medical record as necessary.
  • Seek additional information and/or communicate updates to patients and providers as appropriate throughout the prior authorization process.
  • Engage insurance company representatives and provide required clinical information to secure prior authorization, when necessary.
  • Engage practice operations and incorporate clinical care team when prior authorization attempt is unsuccessful and/or a peer-to-peer and/or alternative medication is required.
  • Escalate complex prior authorization issues to Supervisor, Medication Prior Authorization for assistance/guidance.
  • Maintain working knowledge of St. Luke's electronic medical record system, internal systems and tools, and other online insurance websites.
  • Maintain solution-oriented/creative mindset to effectively anticipate and tend to patient needs by partnering with other organizational team members/departments.
  • Actively participate in performance improvement and continuous quality improvement activities.

Requirements:
  • High School graduate or equivalent.
  • One year practice-based experience or in a similar healthcare setting.

Preferred Qualifications:
  • Customer service experience.
  • Previous prior authorization experience.
  • Previous Medical Assistant experience.