Clinical Authorization Specialist

2 weeks ago

Fairfield, United States Actalent Full time
Job DescriptionJob DescriptionJob Title: Clinical Authorization Specialist
Job Description

We are seeking a Clinical Authorization Specialist to assist our pharmacy team with various tasks related to prescription management, insurance verification, and patient care coordination. The role involves conducting benefits investigations, managing prior authorizations, and ensuring accurate insurance information before medication shipments.

Responsibilities
  • Retrieve, count, pour, and weigh prescriptions per written instruction.
  • Pre-pack medicines, bottle, and label as requested by pharmacy staff.
  • Utilize prior authorization and insurance knowledge to support the intake team for the pharmacy.
  • Conduct benefits investigations and manage prior authorizations for patients.
  • Validate insurance information before medication shipments, especially at the beginning of the year.
  • Utilize computer systems and make phone calls to verify patient and insurance information.
  • Handle dozens of outbound calls, often with significant hold times.
  • Prepare and manage lists of patients, coordinating with insurance companies for multiple patients simultaneously.
  • Maintain patience and professionalism while on hold with insurance companies.
  • Develop daily lists of high-priority patients based on upcoming infusion dates, in coordination with the intake manager and pharmacy team.
  • Make general assignments for patient and payer coordination each day.
  • Ensure efficient use of time during phone calls, with an expected talking time of 25% during peak periods.
  • Potentially receive special assignments from the intake manager.
Essential Skills
  • Prior authorization experience
  • Insurance verification expertise
  • Knowledge of healthcare and medical terminology
  • Patient care skills
  • Pharmacy technician license OR medical assistant certification
  • Experience with insurance knowledge and benefits
  • Medical billing experience
  • Experience with Epic systems
Additional Skills & Qualifications
  • Dedicated worker with reliable transportation
  • Committed to schedule
  • Kind personality
  • Good customer service skills
  • Patient demeanor
Work Environment

The intake department consists of 12 people plus one manager, and the pharmacy team includes over 10 pharmacy technicians and 4 pharmacists. The work schedule is Monday to Friday, 9 AM to 5:30 PM, with a 30-minute break each day. Expect to work at least 8 hours daily during the first weeks of January due to high demand. The contract will start the first week of December and is expected to last until late February or early March 2025. The environment is unique, with a closed-door setting, meaning there is no face-to-face interaction with patients. This role offers an opportunity to gain valuable skills and experience that will enhance your marketability in the future.

About Actalent

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.

Diversity, Equity & Inclusion

At Actalent, diversity and inclusion are a bridge towards the equity and success of our people. DE&I are embedded into our culture through:

  • Hiring diverse talent
  • Maintaining an inclusive environment through persistent self-reflection
  • Building a culture of care, engagement, and recognition with clear outcomes
  • Ensuring growth opportunities for our people

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.

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