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Form of workCURRENT HOLLAND HOSPITAL EMPLOYEES- Please apply through Find Jobs from your Workday employee account.
As a Prior Authorization Specialist for Holland Hospital Pharmacy Services, you will play a crucial role in helping patients receive critical medications and treatments by efficiently navigating the complexities of Prior Authorization and financial assistance. You will be responsible for interacting with insurance companies, healthcare providers, and patients to ensure timely access to necessary care.
Pay Range: $23.31 - $36.36/hour
Employment Type: Full Time Days, 80 hours every 2 weeks
Schedule: Monday - Friday 7:30 am - 4:00 pm
Requirements: High School Diploma or GED Equivalent required and/or minimum education required by professional license (diploma, associate degree);
Registered Nurse [RN], Licensed Practical [LPN] or Vocational Nurse [LVN], Certified/Licensed Pharmacy Technician [CPhT] OR Certified/Registered Medical Assistant [CMA/RMA], Certified or licensed to practice in State of Michigan, 2-3 years of work experience in retail/specialty pharmacy settings, Prior Authorization and/or patient access environments.
Prior Authorization Management
- Review and complete Prior Authorization requests for medications and other associated services, adhering to hospital policies and payer guidelines.
- Research and maintain detailed knowledge of insurance coverage criteria and Prior Authorization requirements for a wide range of medications and procedures.
- Proactively communicate with physicians and other healthcare providers to gather supporting documentation and clarifications for authorizations.
- Advocate for patients through negotiation with insurance companies to secure approvals for denied or denied-with-appeal authorizations.
- Track and monitor the status of all active Prior Authorizations and ensure timely submission of necessary documentation before deadlines.
- Educate patients on Prior Authorization processes and address questions/concerns within scope of your license, re-routing to pharmacist or other healthcare providers as appropriate.
- Acts as point of contact for complex cases, addressing patient concerns, insurance challenges, and coordinating solutions with appropriate disciplines.
Financial Assistance Management
- Research medication assistance programs (MAP) or additional resources to optimize patient access to vital medications.
- Enroll patients for co-pay cards, foundation grants, and manufacturer-supported programs including eligibility assessments, coordination with patient, pharmaceutical companies and providers as applicable.
- Resolve payer or program denials, support patients, and collaborate with providers for seamless medication access.
Professional Development and Collaboration
- Stay up-to-date on changes in regulations and payer policies related to Prior Authorization
- Participate in training and development opportunities to enhance skills and knowledge.
- Collaborate effectively with other team members across departments and disciplines to ensure smooth workflow and excellent patient experience.
- Communicate effectively with other team members to identify opportunities to modify or enhance workflows to support patient, provider, pharmacy and organizational goals.
- Able to work independently and as part of a professional team in a fast-paced environment.
Required license or certification:
Registered Nurse [RN], Licensed Practical [LPN] or Vocational Nurse [LVN], Certified/Licensed Pharmacy Technician [CPhT] OR Certified/Registered Medical Assistant [CMA/RMA]
Minimum Education/Training Required: High School (or GED) and/or minimum education required by professional license (diploma, associate degree); Certified or licensed to practice in State of Michigan
2-3 years of work experience in retail/specialty pharmacy settings, Prior Authorization and/or patient access environments.
Holland Hospital is an Equal Opportunity Employer, please see our EEO policy
