Position: Pharmacy Prior Authorization Specialist
Location: Waltham, MA
Job Id: 3513
# of Openings: 1
Come join our company! Our Onco360 Pharmacy has an immediate need for a Full-time Pharmacy Prior Authorization Specialist in Waltham, Massachusetts! Seeking candidates who live local to this pharmacy location.
Along with our benefits, we offer quarterly incentive bonuses.
A career with us is more than just a job. It's an opportunity to connect and care for our patients, providers, communities, and each other. We attract extraordinary people who have a strong desire to live our mission – to better the lives of those battling cancer and rare diseases. Compassion is more important than numbers. We value teamwork, respect, integrity, and passion.
We succeed when you do, and our company and management team work hard to foster an environment that provides you with opportunities for both professional and personal growth.
Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers.
Starting at $22.00 and up.
We offer a variety of benefits including:
- 401k with a match
- Paid Time Off and Paid Holidays
- Tuition Reimbursement
- Company paid benefits – life; and short and long-term disability
The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations from insurance carriers by receiving prescriptions, addressing and rectifying rejected claims and conducting necessary third party authorization requests.
Primary Responsibilities:
- Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed.
- Follow prior authorization work flow and policies and procedures.
- Collaborate with other departments to assist in obtaining prior authorizations.
- Review accuracy and completeness of information requested and ensure that all supporting documents are present.
- Receive requests for prior authorizations and ensure that they are properly and closely monitored.
- Consult with supervisor or pharmacist to obtain clearance that treatment regimen is appropriate.
- Process referrals and submit clinical supporting documentation to insurance carriers to expedite prior authorization processes.
- Manage correspondence with insurance companies, physicians and patients as required.
- Look through denials and submit appeals if requested by physician to get them approved from insurance companies.
- Document all prior authorization information including approval dates, prior authorization number in patient profile.
- Proactively work on prior authorizations that are due to be expired.
- Secure patients' demographics and medical information by using great discretion and ensuring that all procedures are in sync with HIPAA compliance and regulation.
Qualifications:
- Good interpersonal skills
- Excellent verbal, written and customer service skills
- Ability to work independently, meet deadlines and be flexible
- Good organizational skills and detail oriented
- Knowledge of medical terminology (including sig codes and Roman numeral), brand and generic names of medications and general pharmacy terminology
- Ability to perform tasks accurately and efficiently when inputting information
- Licensed/registered pharmacy technician or as required by state law
- Basic math and analytical skills
Education/Learning Experience
- Required: High School Diploma or GED. Previous Experience in Pharmacy and Prior Authorizations
- Desired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician (PTCB), Specialty pharmacy experience
Work Experience
- Required: 1+ years pharmacy or prior authorization experience
- Desired: 3+ years pharmacy or prior authorization experience
Skills/Knowledge
- Required: Prior authorization process, CoverMyMeds experience, knowledge/understanding of pharmacy insurance claims, Medicare, Medicaid, and commercial insurance, pharmacy test claim and NCPDP claim rejection resolution, coordination of benefits, NDC medication billing, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills.
- Desired: Specialty pharmacy experience
Licenses/Certifications
- Required: Registration with Board of Pharmacy as required by state law
- Required: Independent worker, good interpersonal skills, excellent verbal and written communications skills, ability to work independently, work efficiently to meet deadlines and be flexible, detail-oriented, great time-management skills
#J-18808-Ljbffr