Prior Authorization Assistant

Independent Health Association•Buffalo, NY

1d•$20

About The Position

The Prior Authorization Assistant facilitates the triage, logging in and out of all prior authorization, appeal and grievance requests, and follow-up on said requests, to ensure that all requests are resolved and completed in a timely manner. The Assistant ensures that all steps involved with the process are completed and all regulatory requirements are met or exceeded. The Assistant may also be assigned to provide high quality, diverse administrative support including but not limited to: faxing prior authorization requests, completing decision letters-faxing and copying, filing, and document scanning preparation. Occasional holidays, weekends and overtime are a requirement of the position.

Requirements

High School diploma or GED required; Associates degree preferred.
One (1) year of experience in pharmacy and/or health insurance operations required OR total six (6) months non-PBD associate (temporary) experience working within the same positions and/or department required.
Proven written and verbal communication skills.
Excellent organizational and time management skills.
Excellent ability to absorb new concepts and adapt to a changing environment.
Exhibit creativity and self-motivation, with ability to effectively solve problems as they arise.
Demonstration of math aptitude for purposes of calculating simple drug requirements when given doses and prices calculations.
Proven examples of displaying the PBD values: Trusted Advisor, Innovative, Excellence, Guardianship, Dedication and Caring.

Nice To Haves

Pharmacy experience strongly preferred.
General knowledge of drug names, therapeutic categories, dosage forms, manufacturers and packaging preferred.
Familiarity with HMO concept, PC skills and pharmacy on-line system preferred.

Responsibilities

Prior Authorization, Appeal & Grievance Request Coordination Assist Clinical Review Pharmacist in making appropriate decision by verifying member and provider eligibility and filing requests into the correct member folder. (Standard: 2 minutes per request /all requests will be triaged within 2 hours of receipt).
Enter data and ensures complete accuracy on all statistics by logging prior authorization requests into pharmacy systems. (Standard: 3.5 minutes per request / All requests will be logged in by end of business day.
Updating information in required documentation systems. May also include transcribing Medical Director decision into systems. (Standard: 7 minutes per request/all requests will be completed within 24 hours of a pharmacist decision).
Correspondence Provide Support for all required letters within required timeframes.
Fax prior authorization requests including requests for additional information and completed requests.
Copy and mail completed requests and related documents.
Prepare completed requests for scanning into documentation systems.
Maintain proper storage of all files, in accordance with the corporate retention policy.
Drug Policy Maintenance Assist the Supervising Pharmacist, Prior Authorization with copying and maintaining drug policies.
Update the drug policy tracker accurately and timely.