About the position
Join the transformative team at City of Hope, where we're changing lives and making a real difference in the fight against cancer, diabetes, and other life-threatening illnesses. City of Hope's growing national system includes its Los Angeles campus, a network of clinical care locations across Southern California, a new cancer center in Orange County, California, and treatment facilities in Atlanta, Chicago and Phoenix. Our dedicated and compassionate employees are driven by a common mission: To deliver the cures of tomorrow to the people who need them today. The Prior Authorization (PA) Technician plays a key role in assisting the clinical review pharmacist with daily tasks. Their responsibilities include collecting clinical information and documentation needed for approving oncology and specialty medical injectables. The technician conducts preliminary treatment reviews, identifies key requirements based on payor guidelines, and ensures accurate HCPCS codes and unit details through quality assurance checks. Additionally, they assist with authorization or payment denials by coordinating payor peer-to-peer reviews and gathering necessary information to support denial appeals.
Responsibilities
- Ability to operate proficiently within the EPIC EHR System.
- Create/update/modify treatment referral shell.
- Navigate through patient chart and treatment plan to extract pertinent clinical information.
- Navigate through various payor authorization portals and identify payor treatment requirements.
- Serve as a clinic liaison with clinic pharmacy and medical staff regarding authorization related questions.
- Support clinical review pharmacist with tracking authorization and payment denial status.
- Conducts quality assurance review of referral shell inputs authorization shells.
- Communicates effectively with all levels of staff.
Requirements
- High School or experience may substitute for minimum education.
- Three years of performing pharmacy related duties.
- Licensed as a Pharmacy Technician with the California State Board.
Nice-to-haves
- PTCB certification, preferred.
- Experience working in a health plan, medical group, or pharmacy benefit manager.
- Pharmacy infusion experience, preferred.
