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PRIOR AUTHORIZATION SPECIALIST

City:  Cincinnati
State:  OH
Job Requisition Number:  175538

Attention current TriHealth employees:

Please apply for this position by submitting an online internal application via SuccessFactors. Please be certain to update your SuccessFactors Employee Profile prior to applying to this position.

PRIOR AUTHORIZATION SPECIALIST: The prior authorization specialist is a Pharmacy Technician or Medical Assistant responsible for coordinating all aspects of the prior authorization process, including insurance verification, formulary reviews, gathering necessary clinical information from electronic medical record, and timely communication with patients, prescribers and physician office staff. Candidates should possess knowledge of third party reimbursement regulations and medical terminology as well as seek out assistance from a pharmacist or physician as necessary. Success in this role will require strong communication, interpersonal, and problem solving skills. This person should be able to interact and communicate effectively with internal and external customers, physician office staff, and all members of the organization.

Essential Functions

• 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.

 

MINIMUM REQUIREMENTS:

EDUCATION: High School Degree or GED; Pharmacy Technician or Medical Assistant; Certified Pharmacy Technician or Certified Medical Assistant;

EXPERIENCE: 2-3 years Clinical;Pharmacy Technician or Medical Assistant

SPECIALIZED KNOWLEDGE: Prior experience with medication; Epic and/or prior authorizations desirable.

Job Title:  PRIOR AUTHORIZATION SPECIALIST

Department Name:  THPP AMBULATORY CARE COORD

Location:  Baldwin

Hourly/Salaried:  Hourly

Employment Status: Full Time Position

Bi-Weekly Hours:80

Shift: Day Shift

Weekend Commitment:  No

Holiday Commitment:  No

On-Call Commitment:  No


Nearest Major Market: Cincinnati

Job Segment: Medical, EMR, Pharmacy, Medical Assistant, Healthcare