Medication Authorization Specialist

Rochester Regional Health•Rochester, NY

1d•Onsite

About The Position

The Medication Authorization Specialist will coordinate and submit medication prior authorization requests to insurance companies, ensuring timely approvals. This role involves monitoring, tracking, and following up on prior authorizations, step therapy requirements, and appeals processes. The specialist will communicate with providers to obtain necessary clinical documentation and assist patients in applying for pharmaceutical assistance programs. Maintaining up-to-date knowledge of manufacturer support programs and eligibility requirements is crucial. The role also includes tracking patient enrollment status and renewal needs for financial programs, contacting patients to explain coverage decisions and financial options, and serving as a key point of contact for patients regarding their cardiology medication access issues. Accurate and timely documentation in the Electronic Health Records (EHR) is required. The specialist will work collaboratively with physicians, nurses, pharmacists, and administrative staff to streamline access workflows and participate in process improvement initiatives to enhance patient experience and medication access efficiency.

Requirements

2 years work experience in a healthcare settings, medical billing, pharmacy, or insurance verification.

Nice To Haves

Associates Degree in healthcare administration or business preferred.
Experience with prior authorizations, pharmacy or specialty medications preferred.
Proficiency in electronic medical records (EMR) systems and Microsoft Office applications.
Excellent communication skills including both oral and written as well as interpersonal skills.
Ability to handle simultaneous tasks paying great attention to detail.
Flexibility and ability to work as a team player.
Understanding of managed care, formularies, and payer policies.
Experience with Electronic Health Records (EHR) systems.
Strong verbal and written skills for interacting with providers, patients, and insurers.
Ability to pay attention to detail and ability to manage high volumes of requests with accuracy.

Responsibilities

Coordinate and submit medication prior authorization requests to insurance companies, ensuring timely approvals.
Monitor, track, and follow up on prior authorizations, step therapy requirements, and appeals processes.
Communicate with providers to obtain necessary clinical documentation for insurance submissions.
Assist patients in applying for pharmaceutical assistance foundation programs, grants, and/or co pay programs
Maintain up-to-date knowledge of manufacturer support programs and eligibility requirements.
Track patient enrollment status and renewal needs for financial programs.
Contact patients to explain coverage decisions, out-of-pocket costs, and available financial options.
Provide empathetic, patient-centered support to help navigate financial barriers to care.
Serve as a key point of contact for patients regarding their cardiology medication access issues.
Document all activities accurately and timely in the Electronic Health Records (EHR)
Work collaboratively with physicians, nurses, pharmacists, and administrative staff to streamline access workflows.
Participate in process improvement initiatives to enhance patient experience and medication access efficiency.
All other duties as assigned.