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Centralized Medication Specialist

2 months ago

Uniontown, Ohio, United States Pioneer Physicians Network Full time
Job Title: Centralized Medication Prior Authorization (PA) Specialist

About the Role:

Pioneer Physicians Network is seeking a highly skilled Centralized Medication Prior Authorization (PA) Specialist to join our team. As a key member of our organization, you will be responsible for coordinating all aspects of the medication prior authorization process, ensuring seamless communication with patients, prescribers, and physician office staff.

Key Responsibilities:

  • Research and investigate Prior Authorization (PA) requirements by insurance company
  • Obtain Prior Authorization status updates from the insurance company and communicate to patient, pharmacy, or physician's office as necessary
  • Submit Prior Authorization application forms and all required supporting documentation to the insurance company
  • Review medical record to obtain necessary patient demographic and clinical information and seek timely clarification from pharmacist or physician as necessary
  • Review Prior Authorization denials and communicate reasons for denial to physicians and patients
  • Serve as a subject matter expert for drug formularies and the prior authorization process in general
  • Follows up with insurance companies in a timely manner regarding Prior Authorizations
  • Provides excellent customer service as evidenced by a willingness and ability to assist customers (both internal and external) with their questions/concerns, treating customers in a friendly and helpful manner, and maintaining a positive attitude

Requirements:

  • High School Degree or GED
  • Pharmacy Technician or Certified Medical Assistant with 2-3 years clinical experience, primary care or pharmacy setting preferred but not mandatory
  • Prior EMR experience with eClinicalWorks and/or prior authorizations desirable
  • Must possess strong keyboarding skills as well as EMR and computer literacy

Benefits:

  • 401(k)
  • Dental insurance
  • Employee assistance program
  • Employee discount
  • Flexible spending account
  • Health insurance
  • Life insurance
  • Paid time off
  • Vision insurance

Work Schedule:

  • Monday to Friday

Experience:

  • ICD-10: 1 year (Preferred)