Medication Prior Authorization Specialist
About The Position
Position is 100% remote Major Responsibilities: Ability to complete insurance verification and eligibility checks. Ability to collect and accurately document initial pre-certification/authorization information if available. Initiates the process for obtaining a required referral/authorization if not obtained. Ability to work assigned Epic work queue, following the department’s workflow process on appropriately transferring, deferring, or removing orders from the work queue. Ability to proactively communicate issues involving customer service and process improvement opportunities to management. Maintains excellent public relations with patients, patient's families and clinical staff as well as demonstrates a willingness and ability to work collaboratively with others for concise and timely flow of information. Maintains knowledge of and reference materials for Medicare, Medicaid and third-party payer requirements guidelines and policies, insurance plans requiring pre-authorization/referral and a list of current accepted insurance plans. Ability to update the patient, physician's office, and any necessary parties, through multiple methods as appropriate (including telephone, in-basket messaging, and electronic medical record), regarding responses and outcomes of the prior authorizations. Ability to act as a liaison between physician's office, patient, and pharmacy benefit manager to initiate and resolve appeals, as needed.
Requirements
- High School Graduate.
- Typically requires 1 year of experience in health care, insurance industry, pharmacy, or medical background.
- Demonstrated ability to identify and understand issues and problems.
- Examines data and draws logical conclusions based on information available.
- Knowledge and ability to articulate explanations of Medicare/HIPAA/EMTALA rules and regulations and comply with updates on insurance pre-certification requirements.
- Mathematical aptitude, effective communication skills and critical thinking skills.
- Understanding of basic human anatomy, medical terminology and procedures for application in the patient referral/pre certification/authorization processes.
- Ability to speak effectively to customers or employees of the organization, maintaining a pleasant, professional demeanor.
- Ability to handle sensitive and confidential information according to internal policies.
- Ability to problem solve in a high profile and high stress area, working independently to set and meet deadlines and prioritize work.
- Demonstrated technical proficiency including experience with insurance verification/eligibility tools, Epic electronic medical record, patient liability estimation tools, Microsoft Office, Internet Explorer and phone technology.
Nice To Haves
- Pharmacy tech experience is preferred
Responsibilities
- Ability to complete insurance verification and eligibility checks.
- Ability to collect and accurately document initial pre-certification/authorization information if available.
- Initiates the process for obtaining a required referral/authorization if not obtained.
- Ability to work assigned Epic work queue, following the department’s workflow process on appropriately transferring, deferring, or removing orders from the work queue.
- Ability to proactively communicate issues involving customer service and process improvement opportunities to management.
- Maintains excellent public relations with patients, patient's families and clinical staff as well as demonstrates a willingness and ability to work collaboratively with others for concise and timely flow of information.
- Maintains knowledge of and reference materials for Medicare, Medicaid and third-party payer requirements guidelines and policies, insurance plans requiring pre-authorization/referral and a list of current accepted insurance plans.
- Ability to update the patient, physician's office, and any necessary parties, through multiple methods as appropriate (including telephone, in-basket messaging, and electronic medical record), regarding responses and outcomes of the prior authorizations.
- Ability to act as a liaison between physician's office, patient, and pharmacy benefit manager to initiate and resolve appeals, as needed.
Benefits
- Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:
- Compensation Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training Premium pay such as shift, on call, and more based on a teammate's job Incentive pay for select positions Opportunity for annual increases based on performance
- Benefits and more Paid Time Off programs Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability Flexible Spending Accounts for eligible health care and dependent care expenses Family benefits such as adoption assistance and paid parental leave Defined contribution retirement plans with employer match and other financial wellness programs Educational Assistance Program
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
Number of Employees
11-50 employees
