• Perform duties assigned by the Billing Supervisor.
• Evaluate medication orders and prescriptions from long-term care facilities.
• Identify high-cost medications requiring authorization for dispensation.
• Liaise with facility staff to gather patient information and clinical documentation.
• Initiate and manage the authorization process for high-cost drugs, ensuring timely approval.
• Collaborate with healthcare providers and payers to address any authorization-related queries or concerns.
• Maintain accurate records of authorization requests, approvals, and denials.
• Provide guidance to facility staff on medication authorization procedures and requirements.
• Stay updated on regulatory guidelines and payer policies related to high-cost drug authorizations.
• Communicate effectively with internal teams and external clients regarding authorization status and issues.
• Participate in training sessions and quality improvement initiatives to enhance authorization processes.
• Assist in resolving any discrepancies or issues related to medication authorizations.
• Stay up to date across different platforms and pharmacies to ensure authorizations are being addressed timely

Job Summary