Prior Authorization Specialist

Blue Ridge Health•Hendersonville, NC

1d•Onsite

About The Position

Blue Ridge Health is currently seeking a Prior Authorization Specialist to be part of their Medical team in Hendersonville, NC. The specialist will collaborate with patients, internal staff, other medical center representatives, and third-party payers to facilitate the smooth exchange of information related to obtaining timely prior authorizations for pharmaceutical and imaging patient needs. Blue Ridge Health's mission is to improve Health, inspire Hope, and advance Healing through access to Compassionate, Affordable, and Quality Care. They are a nonprofit system of Federally Qualified Health Centers (FQHCs) that works closely with communities to meet the ever-changing medical and behavioral healthcare needs of individuals throughout WNC. The organization provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

Requirements

High School Diploma or equivalent, required
Current North Carolina Pharmacy Technician, required
Strong knowledge of pharmacy terminology
Experience working in an interdisciplinary and/or integrative health care model
Proficiency in MS Office programs required.

Nice To Haves

Familiarity with Electronic Health Records (EHR) and other databases, preferred.
Proficiency in Spanish, preferred.

Responsibilities

Applies clinical and pharmaceutical criteria for processing prior authorization requests in a timely manner for pharmacy needs. Reviews notifications of patient prescription rejections via covermymeds.com, faxed document scanned directly to the desktop, or patient notification
Reviews received Medicaid prescription rejections in NCTracks
Applies clinical and pharmaceutical criteria for processing prior authorization requests in a timely manner for imaging needs.
Processes appeals and redeterminations as needed
Assists in provider training or updates on efficiencies related to the prescription or imaging process prior authorization process.
Communicates with appropriate parties in a timely and effective manner for completion of prior authorizations.