Specialty Rx Prior Authorization Specialist

Position Summary: The Prior Authorization Specialist will communicate with insurance carriers and physicians to complete Prior Authorization claims and assist in securing Patient Assistance for eligible patients as required. When needed this technician will also assist the pharmacist and technicians in the medically integrated pharmacy; May also assist pharmacists upon request with any administrative tasks such as processing insurance claims, tracking inventory, and filing paperwork when required. This position will report to the Director of Pharmacy Services
Education/Training & Experience:
Education/Formal Training
Work Experience
Credential/Licensure
REQUIRED:
HS Diploma or equivalent
2-4 years related experience or
4-5 years related experience and/or training or
Equivalent combination of education and experience
PTCB certified or equivalent
TN State Board of Pharmacy Registration
PREFERRED:
Similar vocations through completion of a 2 to 4-year degree
N/A
N/A
SUBSTITUTIONS ALLOWED:
N/A
N/A
N/A
Essential Duties and Responsibilities

• Navigate the health care system and its component parts to achieve prescription fulfillment / administration and improve patient outcomes. Provides advice as the subject matter expert to client sponsors and collaborate with stakeholders on opportunities to expand the health system's services and increase revenue by supporting business plans to enhance pull through opportunity.
• Be able to support patients from an access and affordability perspective so that they can receive their medications in a timely manner and with as little cost burden to them as possible.
• Responsible for Prior Authorization, benefit verifications, EMR documentation etc.
• Quality customer service, must maintain professional and polite manner to all patients, staff, and support individuals
• Responsible for being the primary contact and liaison for and between the company's medical partners and the pharmacy for implementing and de-implementing client Rx benefits
• Serve as primary point of contact responsible for service delivery and serve as the "face to the customer". Develop and maintain close relationships with clinic staff, physician, and pharmacy contacts through personal interactions.
• Understands the intricacies of prescription drug benefits and how they adjudicate
• Provide consultation or expert advice to management. Build trust and confidence in patient services to increase patient referrals and prescription capture rates.
• Provide specialized information on a variety of matters relating to the processing of Prior Authorizations
• Consult and implement process improvements to integrate services for better customer experience for physician, clinic staff, patient, and pharmacy.
• Research financial assistance options for patients through copay cards, foundations, and assistance programs
• Work extended hours when needed to ensure patients receive their medication and to complete business plan objectives.
• Provide backup coverage to support clients and patients in the event of absence of other assigned resources.
• Perform other related duties as assigned.

Qualifications/Experience:
Must have excellent organization, analytical, and follow-up skills; excellent verbal and written communication skills; excellent problem-solving skills; ability to organize and prioritize work assignments; ability to handle multiple priorities in a fast-paced environment; ability to operate equipment such as computers, scanners, and cash registers; must know basic mathematics skills including adding, subtracting, multiplying, and dividing in all units of measure; ability to work independently and efficiently; ability to analyze situations and respond in a timely manner; ability to participate in multi-functional teams; must have strong interpersonal skills and high emotional intelligence; must have the ability to establish and maintain effective working relationships within West Cancer Center. May travel to multiple clinics to perform responsibilities.
Must be proficient in computer applications including word processing and e-mail. Must have knowledge of medication and dose measurement; must have knowledge of pharmacy law and medical terminology. Must be reliable with a keen eye for details. Additional hours may be required.
Work Environment/Physical Demands/Travel:

• Typical clinical environment with moderate noise level.
• Ability to stand, walk, sit and use hand/wrist, climb or balance, talk, hear, see for extended periods of time.
• Ability to work with fumes or airborne particles, risk of electric shock and toxic or caustic chemicals.
• Ability to calculate weight-based dosing. Ability to apply concepts of basic mathematics
• Ability to apply understanding to carry out detailed written or oral instructions. Ability to deal with problems involving a few concrete variables in routine situations.
• Respects the dignity and confidentiality of patients.
• Maintains a excellent attendance record and report on time for work.
• Maintains a professional attitude and appearance.
• Complies with clinic safety policy and procedures.
• Ability to lift up to 50 lbs.
• Some travel may be required.
• Extended hours may be required.