Pharmacy Prior Authorization and Billing Specialist
About The Position
As a Pharmacy Prior Authorization and Billing Specialist, you will perform prior authorizations for medications through medical or pharmacy benefits as determined by the medication and payer, collaborate and communicate with providers and pharmacies to provide timely resolution of authorizations and denials, and may assist in securing patient financial assistance for patients who are under-insured or uninsured. Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression, age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or other status protected by applicable law. ProMedica is a mission-driven, not-for-profit health care organization headquartered in Toledo, Ohio. It serves communities across nine states and provides a range of services, including acute and ambulatory care, a dental plan, and academic business lines. ProMedica owns and operates 10 hospitals and has an affiliated interest in one additional hospital. The organization employs over 1,300 health care providers through ProMedica Physicians and has more than 2,300 physicians and advanced practice providers with privileges. Committed to its mission of improving health and well-being, ProMedica has received national recognition for its clinical excellence and its initiatives to address social determinants of health. For more information about ProMedica, please visit promedica.org/aboutus . Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression, age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or any other legally protected category. In compliance with the Americans with Disabilities Act Amendment Act (ADAAA), if you have a disability and would like to request an accommodation in order to apply for a job with ProMedica, please contact [email protected] Equal Opportunity Employer/Drug-Free Workplace
Requirements
- Associate degree in related field OR Certified Pharmacy Tech OR 5 years of Billing/Insurance Verification experience
- Familiarity with ICD-10 and CPT codes applicable to services rendered
- 5 years of relatable experience in a medical office, retail pharmacy, drug claims processing, or revenue cycle
Nice To Haves
- Specific knowledge of medication prior authorization process
Responsibilities
- perform prior authorizations for medications through medical or pharmacy benefits as determined by the medication and payer
- collaborate and communicate with providers and pharmacies to provide timely resolution of authorizations and denials
- assist in securing patient financial assistance for patients who are under-insured or uninsured
Benefits
- We provide flexible benefits that include compensation and programs to help you take care of your family, your finances and your personal well-being.
- It’s what makes us one of the best places to work, and helps our employees live and work to their fullest potential.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
Number of Employees
5,001-10,000 employees
