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Pharmacy Authorizations SpecialistHourly Riverside, CA, US
8 days ago Requisition ID: 1254
The Pharmacy Authorizations Specialist position is responsible for utilizing their clinical knowledge and excellent customer service skills to provide our patients with smooth service of coordination of care. You will make a difference by bringing your personal touch and clinical experiences that will support our patients and intake team. If you’re passionate about improving the health of others and value teamwork, Infusion for Health is the place for you.
This is a full-time, Monday-Friday position. Additionally, this is a hybrid role where work from home will occur, in addition to working in the Riverside pharmacy.
EDUCATION & EXPERIENCE
- Active state Pharmacy Technician license required as outlined by state guidelines
- Experience with submitting Prior Authorizations for Specialty Disease States such as Rheumatoid Arthritis, Multiple Sclerosis, Crohn’s Disease or Ulcerative Colitis preferred
QUALIFICATIONS & SKILLS
- 2+ years’ experience billing pharmacy and/or medical claims (Commercial, Medi-Cal, and Medicare)
- 1-3 years’ experience submitting prior authorizations
- 1-2 years of work experience as a pharmacy technician in a Specialty and/or Home Infusion setting
- Reliable with a keen eye for detail
- Knowledge of specialty and infusion medication
- Excellent communication and customer service skills
- Analysis and problem-solving skills required
- Experience with insurance/data inquiry systems is preferred
- Experience with CareTend Pharmacy Software is a plus
KEY RESPONSIBILITIES:
- Verifies eligibility with insurances and documents findings in patient account
- Quickly identifies the medical and/or pharmacy benefits for a patient
- Assist the pharmacist in submitting prior authorizations for pharmacy services as requested; validate insurance coverage and communication with patients by telephone, follow up on submitted prior authorization requests and submit claims with approvals as appropriate
- Gather information for the initial referral of new patients
- Helps support intake staff in different capacities and provides pharmacy billing-related knowledge for clean claims output
- Processes insurance claims completely, meeting all contractual requirements for timeliness
- Submit secondary billing in a timely manner with appropriate supporting documentation and payer-specific insurance guidelines to ensure expected revenue is allowed
- Investigate, review, and load accurate patient insurance, including medical and pharmacy coverage, assign coordination of benefits, and run test claims to obtain a valid insurance response on patient medications
- Process prescriptions electronically, type them, and ensure all information is complete and accurate.
- Troubleshoot and resolve billing rejections and subsequently rebill claims to appropriate carriers for all commercial, federal, and state insurance plans.
- Report prescription errors to pharmacists on duty and adhere to Company policies and procedures.
- Communicate with members, patients, payors, network pharmacies, providers, and other ancillary departments to obtain the necessary
- Assists with pharmacy operations such as filling and packaging medications as needed.
The hourly pay range for this role is expected to be between $23-$27. Actual base pay could vary based on factors including but not limited to experience, subject matter expertise, geographic location where work will be performed, and the applicant's skill set. The base pay is just one component of the total compensation package for employees. Other rewards may include an annual cash bonus and a comprehensive benefits package, which includes a 401(k) plan with an employer match.
