Prior Authorization Specialist, Medication Management

St. Luke’s University Health Network•Allentown, PA

2d•Onsite

About The Position

The Prior Authorization Specialist, Medication Management is responsible for the coordination of insurance prior authorizations for applicable patient prescriptions. This role liaises with providers, insurance companies, and patients to perform insurance verification, obtain prior authorizations, and bring the authorization process to resolution.

Requirements

High School graduate or equivalent.
One year practice-based experience or in a similar healthcare setting.

Nice To Haves

Customer service experience.
Previous prior authorization experience.
Previous Medical Assistant experience.

Responsibilities

Monitors prior authorization work queues (WQ(s)) and promptly obtains and/or reviews patient insurance information and eligibility verification required to secure medication prior authorizations.
Utilizes online, fax, and telephony pathways to obtain prior authorizations from insurance companies for prescribed medications and documents medication prior authorizations in the medical record as necessary.
Seeks additional information and/or communicates updates to patients and providers as appropriate throughout the prior authorization process.
Engages insurance company representatives and provides required clinical information to secure prior authorization, when necessary.
Engages practice operations and incorporates clinical care team when prior authorization attempt is unsuccessful and/or a peer-to-peer and/or alternative medication is required.
Escalates complex prior authorization issues to Supervisor, Medication Prior Authorization for assistance/guidance.
Maintains working knowledge of St. Luke’s electronic medical record system, internal systems and tools, and other online insurance websites.
Maintains solution-oriented/creative mindset to effectively anticipate and tend to patient needs by partnering with other organizational team members/departments.
Actively participates in performance improvement and continuous quality improvement activities.
Other related duties as assigned.