3867 - Medication Access Coordinator

Salinas Valley Health-posted 12 days ago
$37 - $47/Yr
Full-time • Mid Level
Salinas, CA
1,001-5,000 employees
Resume
Match Score
Upload and Match ResumeTrack Jobs with Teal

It's fun to work in a company where people truly BELIEVE in what they're doing! We're committed to bringing passion and customer focus to the business. Department: Pharmacy The Prior Authorization Pharmacy Technician works under the direct supervision of a licensed pharmacist. This position supports the pharmacy team by efficiently managing the prior authorization process and assisting with the procurement of prescription medications and durable medical equipment The Prior Authorization Pharmacy Technician will be responsible for verifying patient insurance eligibility and coverage, processing third party payer authorization for medications and DMEs, assisting with calls from pharmacies, physicians, and other medical professionals in support of prior authorization for medication and DME approvals, and providing patient assistance support.

  • Review prescription orders for medications and DME and identify those requiring prior authorization or copay assistance.
  • Verify and complete accurate and timely insurance verification.
  • Completes accurate and timely third-party payer prior authorization requests, including but not limited to ensuring the necessary information needed for an authorization (e.g. demographic information, clinical notes, CPT codes, diagnosis codes), via electronic portals, fax, or phone.
  • Communicate with patients, insurers, and other healthcare professionals to obtain additional clinical information regarding non-covered benefits or coverage issues to support prior authorization approvals.
  • Coordinate with insurance representative to process claims and provide accurate co-pay information for patients.
  • Communicate with program administrators for reimbursement assistance programs sponsored by the drug manufacturer.
  • Research and apply manufacturer coupons and financial patient assistance programs to assist with medication procurement when available.
  • Provide referrals, medical necessity, and clinical supporting documentation to third-party insurances to expedite approval for prior authorizations and ensure that appropriate follow-up is performed.
  • Review denials and submit appeals, if requested by physician, to facilitate approval from thirdpartyinsurance companies.
  • Proactively identify and process prior authorizations nearing expiration to ensure continued patient access.
  • Follow up on pending prior authorization requests to expedite approval and avoid delays in patient medication access.
  • Document all prior authorization information including approval dates, prior authorization number, and determination status in patient profile.
  • Document all prior authorization and patient assistance activities accurately in the electronic medical record system and third-party software (e.g., TherigySTM, PioneerRx, and Epic).
  • Notify pharmacists, providers, and patients regarding the status of prior authorization requests.
  • Maintain up-to-date knowledge of insurance formularies, prior authorization criteria, and changes in regulation.
  • Provide excellent customer service to patients and healthcare providers.
  • Collaborate with the specialty pharmacy, retail pharmacy, transitions of care, and ambulatory care pharmacy team.
  • Identify and report high-cost medications to the Director of Pharmacy and Outpatient Pharmacy Services Manager.
  • Follows HIPAA laws and maintains patient/employee confidentiality.
  • Performs other duties as assigned.
  • High school diploma or GED required.
  • Current California Pharmacy Technician license and Nationally Certified Pharmacy Technician (PTCB) required.
  • Three (3) years’ experience in retail pharmacy required.
  • Ability to operate computer and working knowledge of programs, such as word processing, spreadsheets, and presentations.
  • Proficient with electronic medical records and clinical documentation.
  • Prior Authorization pharmacy experience preferred.
  • Specialty pharmacy experience preferred.
  • English/Spanish preferred.
Track Jobs with Teal

Job Search Resources

•
Resume Builder
•
Resume Examples
•
Cover Letter Examples

Tools

Career Hubs

Guides

Company

© 2024 Teal Labs, Inc
Privacy PolicyTerms of Service