Authorization Management Grant Coordinator

2 weeks ago

MagstattleBas, Grand Est, United States Amber Specialty Pharmacy Full time

Company Overview:
At Amber Specialty Pharmacy, we prioritize exceptional patient care. Join a team dedicated to making a significant difference in the lives of individuals facing complex health challenges.

Work Schedule:
Monday to Friday: 8:00 AM - 5:00 PM
No Weekend Shifts
Enjoy Six Paid Holidays
Generous Paid Time Off (PTO)
Hourly Compensation: $18.50 to $20.00 based on experience

Position Title: Grant Specialist, Authorization Management
Department: Operations
FLSA Status: Non-Exempt

Role Overview:
The Authorization Management team plays a crucial role in gathering, analyzing, and responding to essential patient information. The Grant Specialist will focus on claims that have been denied, ensuring the application for Patient Assistance Programs (PAP) and co-pay cards is utilized effectively while maintaining communication with relevant stakeholders, including prescriber offices. All activities will be documented in the electronic medical record system. The primary goal is to identify alternative solutions or appeal denials promptly for patients awaiting their medications.

Key Responsibilities:

  • Support operations for Amber Pharmacy and Hy-Vee Pharmacy Solutions (HPS).
  • Adhere to established workflows and company policies.
  • Research and apply for Patient Assistance Programs for eligible patients.
  • Engage with patients regarding the PAP application process and address any issues.
  • Communicate PAP and rejection information to relevant internal departments.
  • Ensure completeness and accuracy of PAP applications prior to submission.
  • Monitor grant amounts, expiration dates, and renewals, updating tracking spreadsheets accordingly.
  • Generate reports related to PAPs and prior authorizations.
  • Document all PAPs and co-pay cards in appropriate spreadsheets.
  • Manage test claims appropriately.
  • Notify internal departments of any potential issues regarding patient or referring client circumstances.
  • Initiate and finalize prior authorizations and appeals for specialty pharmacy.
  • Collaborate with providers, health plans, PBMs, and other specialty pharmacies to share critical information.
  • Communicate with providers and patients to track the status of prior authorizations and appeals.
  • Submit prior authorization and appeal requests as permitted.
  • Maintain accurate and timely records of all prior authorization and appeal documentation.
  • Evaluate and process claims rejected for prior authorization in accordance with company guidelines.
  • Advocate for patients to identify and resolve coverage issues.
  • Assist licensed professionals in reviewing patient charts and payer requirements.
  • Ensure timely and appropriate handling of all PA requests and provider appeals.
Professional Skills:
  • Proficient in MS Excel, Word, and Outlook.
  • Knowledge of insurance verification and online prescription processing.
  • Strong verbal, written, and interpersonal communication skills.
  • Self-motivated with the ability to meet tight deadlines.
  • Ability to collaborate with various levels of management and external partners.
  • Familiarity with Medicare, Medicaid, Commercial Insurance, and related pharmacy programs.
  • Experience with PAP, PA, and co-pay card processes is preferred.
  • Prior experience in resolving rejected pharmacy claims is advantageous.
  • Ability to interpret handwritten patient medical records.
Qualifications:
  • Understanding of the healthcare sector.
  • HIPAA training or ability to handle confidential patient information.
  • Six months or less of relevant work experience.
Education:
  • High school diploma or equivalent.
Licensure and Certification:
Not required, but nationally certified pharmacy technicians are preferred.

Physical Requirements:
  • Ability to remain stationary for extended periods.
  • Occasional movement within the office environment.
  • Frequent use of computers and office equipment.
  • Effective communication skills for information exchange.
  • Attention to detail in close observation.
Work Environment:
  • Standard office setting.
Equipment Utilized:
  • Computers, office machinery, and specific software applications.
Confidentiality:
  • Maintain confidentiality of sensitive personal information.
This job description serves as a guide to assist in achieving company objectives and may not encompass all duties. Amber Specialty Pharmacy retains the right to modify job responsibilities as necessary.

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