Prior Authorization Specialist

Hawaii Island Community Health Center

Job Title: Prior Authorization Specialist

Supervised By: Clinical Pharmacist

Under the direction of the Director of Pharmacy Services and direct supervision of an assigned Clinical Pharmacist, the Prior Authorization (PA) Specialist serves as the primary point of contact for issues related to third-party-mediated medication access at Hawai′i Island Community Health Center (HICHC).

This position may have various work assignments within HICHC. This description is intended to be generic in nature, and as such it does not detail all duties and responsibilities of the job assignment. Various duties, responsibilities and accountabilities may be assigned to an incumbent in this position depending on clinic needs, and may include but not be limited to the following:

Prior Authorization (PA)

• Obtains Prior Authorizations for medications as needed.
• Facilitates processing of Non-Formulary Drugs (aka: drug not covered) and formulary changes to ensure patient access to provider-specified therapy, utilizing the HICHC Therapeutic Interchange Standard Operating Procedure (SOP) as able.
• Collaborates with Medical Providers and infusion centers for HICHC patients needing to receive infusion therapy.

General Duties

• Uses sound judgement in handling calls, especially with upset patients.
• Demonstrates standard of performance (ownership, teamwork, communication, compassion) that supports patient satisfaction and principles of service excellence.
• Follows all health center specific, State and Federal guidelines and procedures.
• Maintains patient confidentiality at all times.
• Informs supervisor of problems, pending issues, and communications within the organization/other departments.
• Reports to work as scheduled and keeps supervisor informed of any changes in schedule.
• Participates in cross-training for other roles within the pharmacy services department and provides coverage for PTO/unanticipated staffing needs as directed by supervisor.

o Including but not limited to other Prior Authorization Specialists, Prescription Specialists and DME Technicians.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.

The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and Experience

• High School diploma or GED certificate required.
• One-year experience as a pharmacy technician or in a related medical field required or any equivalent combination of experience, training and/or education approved by Human Resources.
• Computer knowledge and skills required.
• Knowledge of medical terminology preferred.

Knowledge, Skills and Abilities

• Courteous, honest and professional at all times.
• Strong organizational and communication skills.
• Able to provide innovative input into the development of the clinic and its processes.
• Ability to demonstrate good customer service.
• Ability to follow specific directions.
• Ability to exercise good judgement in handling calls appropriately.
• Demonstrates ethics of confidentiality.
• Ability to cope with stressful situations and maintain a calm and professional demeanor.

Language Skills

• Ability to read and interpret documents such as government regulations and guidelines, patient records, operating and maintenance instructions, procedure manuals, etc.
• Ability to effectively present information and respond to questions from providers, clinical staff, payors and patients.
• Ability to write at a minimal level of competence, including internal reports and memoranda.
• Ability to communicate with diverse groups of people to include staff and providers and patients.
• Ability to communicate effectively with patients and their families to make their visit a pleasant experience.
• Sensitivity to the multicultural nature of the service area population and provide language translation services to patients as needed.

Personal Characteristics

Personal characteristics include: being a team player, self-starter working well with minimal supervision, high integrity, good personal habits, regular work attendance, courteous and friendly, able to work well with diverse groups of people, organization of multiple tasks and projects, and gain and maintain respect of others, both inside and outside HICHC and the communities it serves.

Confidential and Sensitive Information

Because the employee has access to personal and professional data regarding individual employees and their families, personal data regarding individual patients and the families, and/or sensitive company financial data, an essential job result is the maintenance of a high level of confidentiality of the information processed by the employee. Violation of this confidence may result in disciplinary action, including termination of employment.