Prior Authorization Specialist

Johns Hopkins Medicine•Baltimore, MD

18h•$21 - $34

About The Position

Since 1983, Johns Hopkins Care at Home has provided safe, high-quality and cost-effective care in the home and community. Our team links care across multiple sites for patients, families and colleagues in an effort to restore, maintain and promote health and reduce the effects of disease and disability. As part of Johns Hopkins Medicine, we have access to the most innovative treatments and latest research, and we emphasize education and training among our team members. We also collaborate with doctors, nurses and specialists throughout Johns Hopkins Medicine to ensure continuity of your care. Click here to learn about how to elevate your possibilities as you follow one of our employees' journey from a high school graduate to Pharmacy Business Manager, and the relationships she made along the way! We are seeking a skilled Pharmacy Prior Authorization Specialist to join our team. This role, under the direct supervision of the Prior Authorization Supervisor, involves collaborating with pharmacists, medical staff, billing assistants, and external entities such as third-party payers and prescription benefit management companies.

Requirements

High School Diploma or Equivalency
Registration with the Maryland Board of Pharmacy is required upon hire.
PTCB Certification, national certification with the Pharmacy Technician Certification Board required.
Two (2) years pharmacy technician experience.
One (1) year in health care related billing and or retail pharmacy required, three (3) years preferred.

Responsibilities

Process and verify prescriptions for various disease states.
Address and resolve rejected insurance claims.
Conduct and complete third-party prior authorization requests.
Verify prescriptions for non-Hopkins entities when necessary.
Review patient-specific Epic Medical Charts to ensure insurance criteria are met.
Input prior authorization referrals into the Epic Pharmacy Tool Kit.
Assist the patient assistance team in securing access to necessary medications.