Prior Authorization Specialist (Certified Medical Assistant or Pharmacy Technician)

Job Summary

Required Qualifications

• •High School Degree or GED in Pharmacy
• •Pharmacy Technician or Medical Assistant
• •2-3 years' experience Clinical Pharmacy Technician or Medical Assistant
• •Certified Pharmacy Technician
• •Certified Medical Assistant
• •Prior experience with medication Epic
• •Prior experience with prior authorizations
• •Knowledge of third-party reimbursement regulations
• •Medical terminology
• •Strong communication skills
• •Interpersonal skills
• •Problem-solving skills
• •Ability to interact and communicate effectively with internal and external customers
• •Ability to interact and communicate effectively with physician office staff
• •Ability to interact and communicate effectively with all members of the organization
• •Ability to prioritize daily tasks
• •Working knowledge of department's day-to-day operations and initiatives
• •Active participation in meetings, work groups, and committees
• •Participation in departmental and organizational feedback opportunities
• •Ability to assist in the training of new employees
• •Ability to meet or exceed department's internal quality performance metrics
• •Ability to participate in quality improvement activities and projects
• •Ability to meet or exceed department's customer satisfaction targets and goals
• •Commitment to service excellence for internal and external customers
• •Ability to proactively communicate with patients and physician office staff
• •Ability to work collaboratively with pharmacists, prescribers, physician office staff and all members of the health care team
• •Ability to coordinate all aspects of the prior authorization process
• •Ability to document activities appropriately in the electronic medical record
• •Ability to research and investigate Prior Authorization (PA) requirements by insurance company
• •Ability to obtain Prior Authorization status updates from the insurance company
• •Ability to communicate to patient, pharmacy, or physician's office as necessary
• •Ability to submit Prior Authorization application forms and all required supporting documentation to the insurance company
• •Ability to review medical record to obtain necessary patient demographic and clinical information
• •Ability to seek timely clarification from pharmacist or physician as necessary
• •Ability to review Prior Authorization denials
• •Ability to communicate reasons for denial to physicians and patients
• •Ability to serve as a subject matter expert for drug formularies
• •Ability to serve as a subject matter expert for the prior authorization process
• •Ability to follow up with insurance companies in a timely manner regarding Prior Authorizations
• •Ability to provide excellent customer service
• •Ability to assist customers (both internal and external) with their questions/concerns
• •Ability to treat customers in a friendly and helpful manner
• •Ability to maintain a positive attitude
• •Ability to recognize and take personal responsibility to address and recover from service breakdowns
• •Ability to offer patients and guests priority when waiting
• •Ability to work on improving quality, safety, and service
• •Ability to respect cultural and spiritual differences
• •Ability to honor individual preferences
• •Ability to respect everyone's opinion and contribution
• •Ability to speak positively about team members and other departments
• •Ability to value the time of others
• •Ability to be on time, prepared and actively participating
• •Ability to pick up trash
• •Ability to ensure the physical environment is clean and safe
• •Ability to be a good steward of resources
• •Ability to use supplies and equipment efficiently and effectively
• •Ability to look for ways to avoid waste
• •Ability to acknowledge wins
• •Ability to thank team members and others for contributions
• •Ability to show courtesy and compassion with customers, team members and the community
• •Ability to welcome everyone by making eye contact, greeting with a smile, and saying hello
• •Ability to acknowledge when patients/guests are lost and escort them to their destination or find someone who can assist
• •Ability to refrain from using cell phones for personal reasons in public spaces or patient care areas
• •Ability to climb
• •Ability to concentrate
• •Ability to engage in continuous learning
• •Ability to hear conversation
• •Ability to kneel
• •Ability to lift less than 10 lbs
• •Ability to lift 50+ lbs
• •Ability to lift 11-50 lbs
• •Ability to pull
• •Ability to push
• •Ability to reach
• •Ability to read
• •Ability to sit
• •Ability to stand
• •Ability to stoop
• •Ability to think and reason
• •Ability to use hands
• •Ability to have color vision
• •Ability to walk
• •Ability to greet with a smile
• •Ability to say hello
• •Ability to say 'hello'
• •Ability to make eye contact
• •Ability to escort patients/guests to their destination
• •Ability to find someone who can assist
• •Ability to address and recover from service breakdowns
• •Ability to offer priority when waiting
• •Ability to improve quality, safety, and service
• •Ability to respect cultural differences
• •Ability to honor individual preferences
• •Ability to respect opinions
• •Ability to speak positively
• •Ability to be on time
• •Ability to be prepared
• •Ability to participate actively
• •Ability to pick up trash
• •Ability to ensure environment is clean and safe
• •Ability to be a steward
• •Ability to use supplies efficiently
• •Ability to use equipment efficiently
• •Ability to avoid waste
• •Ability to acknowledge wins
• •Ability to thank team members
• •Ability to show courtesy
• •Ability to show compassion
• •Ability to welcome everyone
• •Ability to greet with a smile
• •Ability to say hello
• •Ability to make eye contact
• •Ability to acknowledge when patients/guests are lost
• •Ability to escort them to their destination
• •Ability to find someone who can assist
• •Ability to refrain from using cell phones
• •Ability to recognize service breakdowns
• •Ability to take personal responsibility
• •Ability to address service breakdowns
• •Ability to recover from service breakdowns
• •Ability to offer priority
• •Ability to improve quality
• •Ability to improve safety
• •Ability to improve service
• •Ability to respect cultural differences
• •Ability to honor individual preferences
• •Ability to respect opinions
• •Ability to speak positively
• •Ability to be on time
• •Ability to be prepared
• •Ability to participate actively
• •Ability to pick up trash
• •Ability to ensure environment is clean
• •Ability to ensure environment is safe
• •Ability to be a steward
• •Ability to use supplies efficiently
• •Ability to use equipment efficiently
• •Ability to avoid waste
• •Ability to acknowledge wins
• •Ability to thank team members
• •Ability to thank others
• •Ability to show courtesy
• •Ability to show compassion
• •Ability to welcome everyone
• •Ability to greet with a smile
• •Ability to say hello
• •Ability to make eye contact
• •Ability to acknowledge when patients/guests are lost
• •Ability to escort them to their destination
• •Ability to find someone who can assist
• •Ability to refrain from using cell phones
• •Ability to recognize service breakdowns
• •Ability to take personal responsibility
• •Ability to address service breakdowns
• •Ability to recover from service breakdowns
• •Ability to offer priority
• •Ability to improve quality
• •Ability to improve safety
• •Ability to improve service
• •Ability to respect cultural differences
• •Ability to honor individual preferences
• •Ability to respect opinions
• •Ability to speak positively
• •Ability to be on time
• •Ability to be prepared
• •Ability to participate actively
• •Ability to pick up trash
• •Ability to ensure environment is clean
• •Ability to ensure environment is safe
• •Ability to be a steward
• •Ability to use supplies efficiently
• •Ability to use equipment efficiently
• •Ability to avoid waste
• •Ability to acknowledge wins
• •Ability to thank team members
• •Ability to thank others
• •Ability to show courtesy
• •Ability to show compassion

Desired Qualifications

• •Certified Pharmacy Technician or Certified Medical Assistant desired
• •Prior experience with medication Epic and/or prior authorizations desirable