Prior Authorization Pharmacy Specialist I

Florida Cancer Specialists•Florida - Remote, FL

1d•Remote

About The Position

The Prior Authorization Pharmacy Specialist is responsible for completing prior authorizations and appeals for oral oncology and supportive medications as an extension of the FCS medical practice. The specialist interacts with patients, caregivers, and healthcare providers about prescription status and supports pharmacy staff and other healthcare professionals with prescription processing to help ensure prompt service and quality patient care. The role includes reviewing patient charts using appropriate criteria, obtaining authorization approvals through online portals, fax, and phone, and processing appeals for denied authorizations. It may involve interpreting clinical information or handling deviations from standard procedures; complex clinical concerns are escalated to the appropriate clinician.

Requirements

High school diploma or GED.
Active Registered Florida Pharmacy Technician license and active pharmacy technician registration in the state of residence.
Active National Pharmacy Technician Certification.
At least three years of experience in a healthcare or customer-service-related field.
Strong interpersonal skills, including effective verbal and written communication.
Solid time-management skills and ability to prioritize multiple tasks.
Ability to collaborate across levels of management, departments, and teams.
Ability to negotiate problems and explore solutions with physicians.

Nice To Haves

Prior Authorization Certified Specialist (PACS) certification.
Pharmacy benefit prior authorization experience.
Hematology/oncology experience.
Experience in pharmacy or a call center.

Responsibilities

Communicate effectively and provide premier customer service when interacting with internal and external parties.
Perform clinical reviews of patient charts using appropriate criteria to complete prior authorizations.
Process appeals for prior authorization denials according to insurance plan requirements, provide documentation, and compose letters of medical necessity when appropriate.
Obtain prior authorization approvals through online authorization sites such as Eviti, New Century Health, and Cover My Meds, as well as by fax and phone.
Interpret clinical information or deviations from standard procedures when required.
Escalate complex clinical concerns to the appropriate clinician, with a goal of first-call resolution.
Comply with accreditation standards, applicable federal and state laws and regulations, and company and departmental policies and procedures, including patient privacy, safety, IT, HR, compliance, and disaster recovery requirements.
Participate in the pharmacy’s Continuous Quality Improvement program by identifying and reporting quality-related events.
Perform additional tasks as needed to support the team and FCS.