Supervisor - Pharmacy Prior Authorization

Onco360-posted 6 days ago
Full-time • Mid Level
Woodridge, IL
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Onco360 Pharmac y has a need for qualified candidates to fill our role of Pharmacy P rior Authorization Supervisor . This is an e xcellent opportunity to join our company and help with our expanding Specialty Pharmacy program! This is a full-time position, Monday to Friday 10:30am to 7pm CST. Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers. A career with us is more than just a job. It's an opportunity to connect and care for our patients, providers, communities and each other. We attract extraordinary people who have a strong desire to live our mission - to better the lives of those battling cancer and rare diseases. Compassion is more important than numbers. We value teamwork, respect, integrity, and passion. We succeed when you do, and our company and management team work hard to foster an environment that provides you with opportunities for both professional and personal growth. Salary starting at $58k and up depending on experience The Prior Authorization Supervisor is responsible for all aspects relating to initiating prior authorizations, completing prior authorization forms via webtools such as CoverMyMeds or insurance specific forms including clinical information from clinical notes provided by prescribers, adjudicating test or live claims to review rejections, and following up on PA requests with insurance companies, while taking prescriber preferences into account. This role requires advanced program knowledge and will provide quality control by routinely examining cases completed by team members.

  • Supervises prior authorization staff in a leadership role to maintain a positive working environment by creating synergy and teamwork to minimize employee relations issues and reduce turnover.
  • Communicates effectively across pharmacy and/or corporate teams and with patients, and successfully resolves issues.
  • Assists Director of Pharmacy Operations in day-to-day pharmacy operations and in implementing new procedures to ensure that the accurate and timely dispensing of quality pharmacy services is consistently delivered to all patients using effective service leadership and customer skills.
  • Works with pharmacy management to recruit, select, hire, orientate, develop, and train new associates.
  • On an ongoing basis, evaluates, coaches, and utilizes performance management practices to motivate and set expectations for PA staff.
  • In collaboration with management, drafts and delivers effective corrective action plans and disciplinary action to technicians performing at substandard levels.
  • Manages and reports on daily activity of vertical team members, including monitoring of daily workflow and Pulse reporting.
  • Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding prior authorization information.
  • Runs test claims or live claims to check for payable claims or for valid insurance rejections on medications that require prior authorizations and initiate Prior Authorization requests, using appropriate insurance forms or CoverMyMeds.
  • Reviews accuracy and completeness of information and ensure supporting clinical documentation is included if required.
  • Contacts insurance companies to follow up on prior authorization requests, including determining if any additional information is needed, or whether the claim is in review, approved, or denied.
  • Document all prior authorization information in patient profile.
  • Provides guidance to providers and patients in connection with documentation required for payer coverage, support with appeals for denied claims, and follow up with payer to determine outcome.
  • Handles escalations for difficult claim rejection resolution cases/questions to ensure accurate and timely completion of adjudication.
  • Provides ongoing access and training on web tools to the PA team and offers frontline support to address system functionality questions and issues (Ex: CMM, insurance portals, PA-related websites, portals and applications, etc.)
  • Works with Prior Authorization Manager and/or Director of Pharmacy Operations on other responsibilities, projects, implementations, and initiatives as needed.
  • Maintains a safe and clean pharmacy by complying with procedures, rules, and regulations and compliance with professional practice and patient confidentiality laws.
  • Contributes to team effort by accomplishing related tasks as needed and other duties as assigned.
  • High School Diploma or GED.
  • 4+ years pharmacy or prior authorization experience, previous leadership experience
  • Prior authorization process, CoverMyMeds experience and other prior authorization platforms, prior authorization insurance forms, knowledge/understanding of pharmacy insurance claims, Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, NDC medication billing, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, advanced typing, math and analytical skills.
  • Registration with Board of Pharmacy as required by state law
  • Independent worker, good interpersonal skills, excellent verbal and written communications skills, ability to work independently, work efficiently to meet deadlines and be flexible, detail-oriented, great time-management skills, leadership
  • Associates or Bachelor’s Degree
  • Certified Pharmacy Technician (PTCB)
  • Specialty pharmacy experience
  • 5+ years pharmacy or prior authorization experience, 1+ years supervisor experience, Specialty pharmacy experience
  • Specialty pharmacy operations, leadership skills, independent decision-making abilities, able to conduct research, be resourceful, and self-reliant, excellent communication skills
  • Certified Pharmacy Technician (PTCB), Advanced Certified Pharmacy Technician with completion of Billing and Reimbursement certification
  • Medical
  • Dental
  • Vision
  • 401k with a match
  • Paid Time Off and Paid Holidays
  • Quarterly Incentive Bonuses
  • Tuition Reimbursement
  • Company paid benefits – life insurance
  • short and long-term disability
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