Pharmacy Support Analyst - Prior Authorization Team

SUMMARY

We are currently seeking a Pharmacy Support Analyst to join our Pharmacy Administration Prior Authorization team. The current vacancy is full time with benefits, 80 hours per pay period, Monday - Friday, day shift.

In addition to minimum qualifications, preferred applicants must have current registration with the Minnesota Board of Pharmacy and PTCB or CPhT certification.  Pharmacy Tech work experience highly preferred.

Under the direct supervision, responsible for providing coordination, clarification and communication of all financial aspects of pharmacy, including insurance and authorization verification, claims research, patient assistance, and formulary management.  In addition, the individual will support the Pharmacy department by leading projects and developing processes needed for day-to-day business activities.

RESPONSIBILITIES

• Verifies insurance coverage and obtains authorizations and certifications for the patient's medication treatment 
• Obtains all necessary signatures and documentation required by the patient's third party payer
• Accurately and completely documents all information into EPIC to ensure maximum reimbursement
• Monitors and updates information regarding insurance data, authorizations, and preferred providers. Partners with the clinical care team and insurance provider to ensure continued coverage of patient's care and maximum reimbursement and minimized financial impact to the patient
• Provides financial advocacy, assistance and support to patients and families, as needed. Assists patients who are un-insured to access other funding resources and completes required documents. Maintains current working knowledge of Medicare, Medicaid and other program benefits and criteria, particularly as they pertain to pharmacy benefits
• Serves as a liaison between the facility and community/manufacturers in making patient assistance resources available to the patient and family
• Acts as a liaison between patient/hospital/provider/payer to enhance account receivables performance, resolve outstanding issues and/or patient concerns, and maximize service excellence
• Monitors pharmacy claim data and EPIC work queues to identify critical reimbursement issues and works with Finance and Billing to resolve them in an expedient and proactive manner
• Understand charge master set up and maintenance requirements
• Work with Pharmacy leadership on internal audits and external audits from 3rd party payors and government agencies, including but not limited to Medicaid and Medicare
• Obtains knowledge of payer requirements and policy benefit structure, including Medicare and Medicaid
• Keeps current on payer trends and changes utilizing websites, emails and bulletin communications
• Continually reviews and monitors billing and coding changes affecting Pharmacy
• May work directly with providers to obtain Prior Authorizations for medications
• Provides leadership and training to other members of the team and serves as a resource for internal and external customers

 

QUALIFICATIONS

Minimum Qualifications:

• Associate's Degree, with a focus on healthcare or finance
• 3 year's professional experience working in pharmacy business office, payer business office or equivalent area

-OR- 

• An approved equivalent combination of education and experience

Preferred Qualifications:

• Bachelor's degree in Business Administration, Health Care Administration
• Nursing, Health Information Management or related healthcare concentration area

Knowledge/ Skills/ Abilities:

• Requires extensive knowledge of government and commercial payer requirements to ensure accurate and compliant charging and billing of medications
• Demonstrated expertise in logical thinking, data preparation and analysis 
• Comprehensive knowledge of Microsoft Office (Outlook, Word, Excel and Access) 
• Strong communication skills, both verbal and written
• Knowledge of medical and pharmacy terminology
• Ability to communicate effectively with medical providers