Prior Authorization Specialist

TriHealth•Montgomery, OH

8d•Onsite

About The Position

Join TriHealth at Montgomery Fitness Pavilion as a Prior Authorization Specialist, where you'll play a vital role in helping patients access the care and services they need. In this position, you'll collaborate closely with providers, clinical teams, patients, and insurance companies to ensure authorizations are obtained accurately and efficiently, helping create a seamless patient experience. Montgomery Fitness Pavilion offers a welcoming, team-oriented environment focused on wellness, preventive care, and exceptional service. If you're detail-oriented, enjoy problem-solving, and thrive in a fast-paced healthcare setting where your work directly supports both patients and caregivers, this is an opportunity to make a meaningful impact while growing your career with a respected healthcare organization.

Requirements

High School Degree or Medical Assistant
2-3 years experience Clinical Pharmacy Pharmacy Technician or Medical Assistant

Nice To Haves

Certified Pharmacy Technician or Certified Medical Assistant desired
Prior experience with medication Epic and/or prior authorizations desirable
Candidates should possess knowledge of third party reimbursement regulations and medical terminology as well as seek out assistance from a pharmacist or physician as necessary.
Success in this role will require strong communication, interpersonal, and problem solving skills.
This person should be able to interact and communicate effectively with internal and external customers, physician office staff, and all members of the organization.

Responsibilities

Demonstrates the ability to prioritize daily tasks and has a working knowledge of department’s day-to-day operations and initiatives. Is an active participant in meetings, work groups, and committees. Participates in departmental and organizational feedback opportunities. Assists in the training of new employees. Meets or exceeds department's internal quality performance metrics. Participates in quality improvement activities and projects to monitor the effectiveness of department's services.
Meets or exceeds department’s customer satisfaction targets and goals. Assumes responsibility for achieving department satisfaction goals and demonstrates a commitment to service excellence for internal and external customers. Proactively communicates with patients and physician office staff. Serves as a subject matter expert for the prior authorization process as a whole. Meets or exceeds department’s goals for formulary adherence measures, and other cost control initiatives identified as a priority for the department. Works collaboratively with pharmacists, prescribers, physician office staff and all members of the health care team to coordinate all aspects of the prior authorization process and documents activities appropriately in the electronic medical record.