Authorization Management Specialist

Hy-Vee, Inc.•Omaha, NE

11d•Onsite

About The Position

Amber Specialty Pharmacy is seeking an Authorization Management Specialist to join our Operations Department. This role is responsible for preparing appeal summaries and prior authorizations, corresponding with prescriber's offices, and documenting information in the electronic medical record. The specialist will gather pertinent patient history and information, evaluate it, prepare responses, and complete appeals and prior authorizations accurately and timely. This position offers fulfillment in a career where you can make a positive impact on patients with complex and chronic conditions. Amber Specialty Pharmacy is a wholly owned subsidiary of Hy-Vee, Inc., specializing in managing rare and chronic conditions and providing comprehensive clinical support and patient management.

Requirements

Working knowledge of the healthcare industry
HIPPA trained and/or the ability to work with and protect highly confidential patient and employee information
Six months or less of similar or related work experience
Proficient with MS Excel, Word, and Outlook
Understanding of insurance verification and online prescription adjudication
Strong oral, written, and interpersonal skills
Self-initiative
Demonstrated ability to meet tight deadlines
Ability to work with all levels of internal management and staff, as well as outside clients and vendors
Working knowledge of Medicare, Medicaid, Commercial Insurance, and renal programs related to pharmacy, billing, grants, co-pay cards, prior authorizations, and rejections
Must be able to remain in a stationary position up to 90% of the time
Must occasionally move inside the office to access file cabinets, machinery, etc., and traverse conferences, meetings, and remote events
Constantly operates a computer and other office productivity machinery, such as a calculator, copy machine, and computer printer
The ability to communicate information and ideas so others will understand.
The ability to observe details at close range (within a few feet of the observer)
Must lift and traverse the area to move paper and supplies to use the equipment.
Frequently interact with co-workers, intradepartmental staff of the Company, managers, leaders, insurance providers, payers, vendors, and customers.
The incumbent must maintain the confidentiality of personal information for the applications and licensing requirements, including any financial, strategic, or proprietary information.
Candidates must be able to pass a pre-employment drug test, background check, and health screening (if applicable).

Nice To Haves

Prior PAP, PA, and co-pay card experience preferred
Previous experience troubleshooting rejected pharmacy claims preferred
Proficiently read and understand abstract information from handwritten patient medical records
Nationally Certified Pharmacy Technicians preferred
Application for certification within state-specified criteria

Responsibilities

Initiates and completes prior authorizations and appeals for specialty pharmacy
Work directly with providers, health plans, PBMs, and other specialty pharmacies to relay vital information and provide a high level of service
Communicates with providers, health plans, PBMs, and patients to obtain the status of pending prior authorizations and appeals
Submits prior authorization and/or appeal requests via electronic, phone, or fax on behalf of physicians/providers as allowed
Assures that all prior authorization and appeal documents, databases, and records are maintained accurately and timely
Evaluate and process claims rejected for prior authorization following company policies and procedures
Advocates on the patient's behalf to identify and assess coverage issues
Assists licensed professionals in reviewing patient chart notes and payer requirements to determine why cases are an appropriate course of action
Assures timeliness and appropriateness of all PA requests and provider appeals according to state, federal, and company guidelines
Adheres to all company policies as indicated in the handbook and directives issued by management.
Has reviewed Accreditation Policy and Procedure manual