Grant Specialist, Authorization Management

Amber Specialty Pharmacy•Omaha, NE

2d•Onsite

About The Position

The Grant Specialist works within the prior authorization team to help patients obtain prescriptions by addressing claims denied for payment, researching patient assistance programs and copay cards, exploring financial assistance, and appealing denials. The role communicates with patients, prescribers, providers, health plans, pharmacy benefit managers, and other specialty pharmacies, and records work in the electronic medical record. The position supports Amber Pharmacy and Hy-Vee Pharmacy Solutions and follows established departmental workflows and policies. The Grant Specialist researches and submits Patient Assistance Program applications, checks grant amounts and expiration dates, renews programs when applicable, tracks grants and copay cards, and produces related reports. The position also initiates and completes prior authorizations and appeals, processes claims rejected for prior authorization, and maintains accurate and timely records. Work is conducted in a normal office environment and requires regular computer and office-equipment use. The role is scheduled Monday through Friday, 8 a.m. to 5 p.m. CST, with no weekends. The hourly wage is $19.00 to $20.00.

Requirements

High school diploma or equivalent.
Six months or less of similar or related work experience.
Working knowledge of the healthcare industry.
HIPAA training and/or the ability to work with and protect highly confidential patient and employee information.
Proficiency with Microsoft Excel, Word, and Outlook.
Understanding of insurance verification and online prescription adjudication.
Strong oral, written, and interpersonal communication skills.
Self-initiative and 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.
Ability to read and understand abstract information from handwritten patient medical records.
Ability to remain stationary for up to 90% of the time, occasionally move around the office, operate a computer and other office productivity equipment, communicate and exchange accurate information, and observe details at close range.
Ability to lift and move paper and supplies to use equipment.
Must pass required pre-employment drug and background tests; health screening may also apply if applicable.

Nice To Haves

Prior Patient Assistance Program, prior authorization, and copay card experience.
Previous experience troubleshooting rejected pharmacy claims.
Nationally Certified Pharmacy Technician certification is preferred.

Responsibilities

Provide support for Amber Pharmacy and Hy-Vee Pharmacy Solutions while maintaining departmental workflows and following company and department policies and procedures.
Research and apply to Patient Assistance Programs for patients in need.
Contact patients and refer clients regarding Patient Assistance Program applications, processes, or rejection issues.
Share information about Patient Assistance Programs and claim rejections with appropriate internal departments.
Ensure Patient Assistance Program applications are complete and accurate before submission to foundations when applicable.
Check remaining grant amounts and expiration dates, renew Patient Assistance Programs when applicable, and update the grant-tracking spreadsheet using daily reports.
Create reports related to Patient Assistance Programs and prior authorizations.
Track Patient Assistance Program and copay card activity in the appropriate spreadsheets.
Reverse or void test claims.
Notify appropriate internal departments about patient or referring-client circumstances that could become problems.
Initiate and complete prior authorizations and appeals for specialty pharmacy.
Work with providers, health plans, pharmacy benefit managers, and other specialty pharmacies to relay information and provide service.
Communicate with providers, health plans, pharmacy benefit managers, and patients to obtain the status of pending prior authorizations and appeals.
Submit prior authorization and appeal requests electronically, by phone, or by fax on behalf of physicians or providers as allowed.
Maintain prior authorization and appeal documents, databases, and records accurately and promptly.
Evaluate and process claims rejected for prior authorization according to company policies and procedures.
Advocate for patients by identifying and assessing coverage issues.
Assist licensed professionals in reviewing patient chart notes and payer requirements to determine appropriate courses of action.
Ensure prior authorization requests and provider appeals are timely and appropriate under state, federal, and company guidelines.
Maintain confidentiality of personal, financial, strategic, and proprietary information.