Pharmacy Technician Prior Authorization Specialist

Description

Job Description

PeaceHealth is seeking a Pharmacy Technician Prior Authorization Specialist for a Full Time, 1.00 FTE, Day position.

The salary range for this job opening at PeaceHealth is $28.73 – $43.09.

The hiring rate is dependent upon several factors, including but not limited to education, training, work experience, terms of any applicable collective bargaining agreement, seniority, etc.

Job Summary

Responsible for review and verification of prior authorization requests, including referral documentation, for chemotherapy and infusion service clinical areas. Provides customer service and support for clinical areas and patients relative to receipt of prior authorizations.

Essential Functions

• Searches for irregularities in chemotherapy and other infusion service referral and authorization records and assists to obtain payer authorization. Ensures insurance carrier documentation requirements are met and referral support documentation is filed in patient’s medical record. Sends requests for missing prior authorization information and correction of existing prior authorization documentation to the referral coordinator team.
• Follows a defined algorithm to ensure prior authorizations are in place prior to patient receiving administration of medication. Refers to appropriate provider, clinician, or caregiver for provider approval to change the date of scheduled medication administration when lack of prior authorization will result in patient financial toxicity.
• Uses electronic resources including Outlook, Teams, SharePoint, and Excel to connect teammates from different service areas to resolve irregularities. Tracks irregularities and communicates in real time to lower overall payer denials.
• Efficiently manages correspondence with providers and provider teams, specialists, and insurance companies. Documents pertinent information in appointment and referral work queues and/or in the medical record.
• Works in collaboration with chemotherapy and infusion services teams, pharmacy, providers and provider teams, patient financial services, referral and pre-authorization specialists, and medication assistance program specialists to improve the Revenue Cycle process. Continually improve work process to enhance service and customer relations.
• Performs other duties as assigned.
  
  

Qualifications

• Associate Degree Preferred: or two years college in a healthcare related field or comparable experience and expertise which provides the incumbent the requisite knowledge and skills to successfully perform the responsibilities of this job may be considered
• Minimum of 3 years Required: pharmacy services experience and
• Minimum of 3 years Preferred: demonstrated experience in insurance requirements for referrals and/or prior authorizations to various chemotherapy, medication administration, and infusion service centers
• Required: within 1 Year Certified Pharmacy Technician - National and
• Required: Upon Hire Certified Pharmacy Tech - Washington
  
  

Skills

• Proficient computer skills including MS Office applications and the electronic health record. (Required)
• Ability to navigate and utilize internet-based applications quickly and efficiently. (Required)
• Strong verbal and written communication. (Required)
• Ability to work both independently and interdependently with staff, providers, and individuals outside of the organization with limited or no supervision. (Required)
  
  

Working Conditions

• Ability to move around area with occasional sitting.
• Occasional squatting/ kneeling/ bending.
• Fine motor skills to be able to grasp to perform precise procedures frequently.
• Frequent reaching.
• Lift/Carry: Occasionally up to 30 lbs.
• Push/Pull: Occasionally up to 14 lbs. force.
• Exposure to toxic or caustic chemicals.
• Vision and hearing required within normal limits (glasses, contacts, hearing aids permitted).
• Ability to communicate and exchange accurate information.
  
  

PeaceHealth is committed to the overall wellbeing of our caregivers: physical, emotional, financial, social, and spiritual. We offer caregivers a competitive and comprehensive total rewards package. Some of the many benefits included in this package are full medical/dental/vision coverage; 403b retirement plan employer base and matching contributions; paid time off; employer-paid life and disability insurance with additional buyup coverage options; tuition and continuing education reimbursement; wellness benefits, and expanded EAP and mental health program.

See how PeaceHealth is committed to

For full consideration of your skills and abilities, please attach a current resume with your application. EEO Affirmative Action Employer/Vets/Disabled in accordance with applicable local, state or federal laws.