Pharmacy Prior Authorization Specialist

Seattle Children's Hospital • Seattle, WA

4d • Onsite

About The Position

The Prior Authorization (PA) Specialist is responsible for all aspects of the prior authorization process while continuously monitoring and ensuring compliance through established procedures and documentation. Responsibilities include collecting all the necessary documentation, contacting the client for additional information to complete the PA process. Complete, timely, and accurate identification and submission of prior and retro authorization requests to payors. Interacts with clients, insurance companies, patients, as necessary, to request for prior authorizations. Responsible for documenting account activity, updating patient and claim information and demonstrates proficiencies with Epic, CoverMyMeds, and other billing platforms to ensure all functionalities are utilized for the most efficient processing of claims and identifies PA trends and/or issues resulting in delayed claims processing. Provides the highest level of customer service to internal care teams and patients and families.

Requirements

• High school graduate or G.E.D.
• Graduation from accredited pharmacy technician training program, or equivalent training
• Minimum of three (3) years of retail or outpatient pharmacy practice experience
• Licensed by the Washington State Pharmacy Department of Health as a pharmacy technician

Nice To Haves

• One (1) year Seattle Children's Outpatient Pharmacy experience
• Specialty Pharmacy and/or Centralized Prior Authorization Services knowledge

Responsibilities

• Responsible for all aspects of the prior authorization process
• Continuously monitoring and ensuring compliance through established procedures and documentation
• Collecting all the necessary documentation
• Contacting the client for additional information to complete the PA process
• Complete, timely, and accurate identification and submission of prior and retro authorization requests to payors
• Interacts with clients, insurance companies, patients, as necessary, to request for prior authorizations
• Documenting account activity
• Updating patient and claim information
• Demonstrates proficiencies with Epic, CoverMyMeds, and other billing platforms to ensure all functionalities are utilized for the most efficient processing of claims
• Identifies PA trends and/or issues resulting in delayed claims processing
• Provides the highest level of customer service to internal care teams and patients and families

Benefits

• medical
• dental
• vision plans
• 403(b)
• life insurance
• paid time off
• tuition reimbursement

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED