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Prior Authorization Specialist

City:  Cincinnati
State:  OH
Job Requisition Number:  248922

The prior authorization specialist is 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

 

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

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

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


Nearest Major Market: Cincinnati

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