Clinical Services Tech

Pharmacy Technician – Prior Authorization Specialist

Prior Authorization Specialists are responsible for assisting patients, health care staff and support staff at the critical care facilities serviced by Medication Review, Inc. The Prior Authorization Specialist provides support by processing Insurance verification and ensuring medications in need of a prior authorization on a patient’s insurance is carried through to approval or denial. The position requires a highly organized, motivated and a skilled problem solver. Attention to detail and processing skills to ensure all necessary steps are taken to accurately identify or process a request for a prior authorization is necessary.

Typical Work Duties (not limited to)

• Communicates with pharmacy and facility to make sure all information is gathered in order to begin authorization process
• Completes phone call with a professional closing
• Obtains any information necessary in order to assist with the authorization process
• Call patients and/or referring offices on Self Pay accounts that may require prior authorization in an effort to identify appropriate insurance
• Clear understanding of the billing process to identify and communicate the codes and forms that may be required to ensure reimbursement
• Be proficient in multiple electronic medical records used by the different MRI facilities for documentation, data collection and general research
• Update patient demographics as needed
• Add and verify patient’s current insurance information. Update as needed
• Responsible to keep all on-line web portals accounts active to ensure access is maintained in order to obtain prior-authorization verification
• Demonstrates appropriate verbal and written communication skills to relay accurate information in a clear, concise manner to peers, staff, management, patients, guests and medical staff
• Initiates appropriate questions and provides timely feedback to lead and management on any issues, policies and procedures, etc.
• Organizes and maintains records to provide accurate reporting, easy access to information and historical data
• Responsible to be aware of assigned work rotations and monthly assignments

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Ability and Requirements

Ability to understand oral and written directions from registered pharmacists; organize and perform work effectively and accurately; operate computers, word processors, understand medical terminology; conceptualize and communicate improvement in functioning pharmacy procedures.

Current Washington State Pharmacy Technician License, in good standing

Preferred

• CPhT Certification
• 2 year’s pharmacy hospital and/or clinical experience