Dedicated Authorization Management Specialist

Hy-Vee, Inc.•Omaha, NE

5d•Onsite

About The Position

Amber Specialty Pharmacy is seeking a Dedicated Authorization Management Specialist to join our Operations Department. This role is responsible for preparing prior authorizations and appeals, corresponding with prescriber's offices, and documenting information in the electronic medical record for an assigned product program. The specialist will gather pertinent patient history and information, evaluate, respond to, and complete appeals and prior authorizations accurately and timely, while providing exceptional customer service. This is an office-based position.

Requirements

High school diploma or equivalent
Working knowledge of the healthcare industry
HIPAA 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, copay cards, prior authorizations, and rejections
Must be able to remain in a stationary position –up to 90% of the time
The person in this position needs to occasionally move about inside the office to access file cabinets, office 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. Must be able to exchange accurate information in these situations
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.
Must pass post-offer, pre-employment drug background tests as allowed by state, federal, local ordinance, statutes and licensing/accreditation requirements.
Candidates must be able to pass a pre-employment drug test, background check, and health screening (if applicable).

Nice To Haves

Nationally Certified Pharmacy Technicians Preferred
Prior PAP, PA, and copay card experience preferred
Prior experience troubleshooting rejected pharmacy claims preferred
Proficiently read and understand abstract information from handwritten patient medical records

Responsibilities

Initiates and completes prior authorizations and appeals for specialty pharmacy for all patients of an assigned product program.
Works 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, Pharma partners, and patients to obtain 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.
Collaborates with program team members on other aspects of the product program, not limited to intake and patient access functions and patient communications and onboarding.
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.