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Pharmacy Preauthorization Specialist - Retail
Pharmacy Preauthorization Specialist - Retail
Full Job Description
Location: Valley View
Biweekly Hours: 80.00
Shift: 10:30a-7:00p, M-F
The MetroHealth System is redefining health care by going beyond medical treatment to improve the foundations of community health and well-being: affordable housing, a cleaner environment, economic opportunity and access to fresh food, convenient transportation, legal help and other services. The system strives to become as good at preventing disease as it is at treating it. Founded in 1837, Cuyahoga County's safety-net health system operates four hospitals, four emergency departments and more than 20 health centers.
Summary:
Processes and obtains authorizations for medication therapy requests initiated by MetroHealth Clinicians for the Specialty Pharmacy. Serves as a primary contact for Specialty Pharmacy benefits verifications and payor preauthorization, and acts as a liaison between patients and representatives of medication assistant programs. Follows up with and resolves issues related to authorizations. Implements denial management protocols as directed. Implements/maintains programs that reduce drug expenses for uninsured and under-insured patients, including through reimbursements of specific drug products, and by assisting patients in accessing pharmaceutical manufacturer patient assistance programs. Coordinates with pharmacy services, clinic physicians, the Social Work department, and patients on preauthorization and medical assistance programs. Ensures that the current Federal, State and other regulatory agencies' requirements are followed. Upholds the mission, vision, values, and customer service standards of The MetroHealth System.
Qualifications:
Required:
Associate's Degree in Healthcare, Business Administration, or another related field, or any equivalent combination of education, training, and experience in addition to the experience stated below.
Meets one of the following:
• 1 year of experience with pharmacy dispensing activities in a hospital pharmacy.
• 2 years of experience with pharmacy dispensing activities in a retail pharmacy.
• 2 years of experience in hospital billing and/or reimbursement.
Knowledge of pharmaceutical reimbursement requirements, principles, and best practices.
Proficient personal computer skills, especially with the Microsoft Office Suite of software including Excel and Word. Strong written, verbal, and interpersonal communication skills, including the ability to communicate effectively with a diverse patient population in a variety of settings
Strong customer service skills. Strong analytical and decision-making skills.
Solid critical thinking and organizational skills.
Ability to work independently and as a member of a team with a high degree of flexibility.
Knowledge of medical terminology.
Preferred:
Bachelor's degree in Healthcare, Business Administration, or another related field.
Current/active Certified Pharmacy Technician from the Pharmacy Technician Certification Board (PTCB).
Experience with EPIC. Experience with CoverMyMeds or other prior authorization process automation tools.
Knowledge of regulations and requirements for government agencies, insurance carriers, and pharmaceutical manufacturers as they relate to medication assistance programs.
Physical Requirements:
May sit, stand, stoop, bend, and ambulate intermittently during the day.
May need to sit or stand for extended periods.
See in the normal visual range with or without correction.
Hear in the normal audio range with or without correction.
Finger dexterity to operate office equipment required.
May need to lift up to twenty-five (25) pounds on occasion.
Ability to communicate in face-to-face, phone, email, and other communications.
Ability to see computer monitor and departmental documents.
Biweekly Hours: 80.00
Shift: 10:30a-7:00p, M-F
The MetroHealth System is redefining health care by going beyond medical treatment to improve the foundations of community health and well-being: affordable housing, a cleaner environment, economic opportunity and access to fresh food, convenient transportation, legal help and other services. The system strives to become as good at preventing disease as it is at treating it. Founded in 1837, Cuyahoga County's safety-net health system operates four hospitals, four emergency departments and more than 20 health centers.
Summary:
Processes and obtains authorizations for medication therapy requests initiated by MetroHealth Clinicians for the Specialty Pharmacy. Serves as a primary contact for Specialty Pharmacy benefits verifications and payor preauthorization, and acts as a liaison between patients and representatives of medication assistant programs. Follows up with and resolves issues related to authorizations. Implements denial management protocols as directed. Implements/maintains programs that reduce drug expenses for uninsured and under-insured patients, including through reimbursements of specific drug products, and by assisting patients in accessing pharmaceutical manufacturer patient assistance programs. Coordinates with pharmacy services, clinic physicians, the Social Work department, and patients on preauthorization and medical assistance programs. Ensures that the current Federal, State and other regulatory agencies' requirements are followed. Upholds the mission, vision, values, and customer service standards of The MetroHealth System.
Qualifications:
Required:
Associate's Degree in Healthcare, Business Administration, or another related field, or any equivalent combination of education, training, and experience in addition to the experience stated below.
Meets one of the following:
• 1 year of experience with pharmacy dispensing activities in a hospital pharmacy.
• 2 years of experience with pharmacy dispensing activities in a retail pharmacy.
• 2 years of experience in hospital billing and/or reimbursement.
Knowledge of pharmaceutical reimbursement requirements, principles, and best practices.
Proficient personal computer skills, especially with the Microsoft Office Suite of software including Excel and Word. Strong written, verbal, and interpersonal communication skills, including the ability to communicate effectively with a diverse patient population in a variety of settings
Strong customer service skills. Strong analytical and decision-making skills.
Solid critical thinking and organizational skills.
Ability to work independently and as a member of a team with a high degree of flexibility.
Knowledge of medical terminology.
Preferred:
Bachelor's degree in Healthcare, Business Administration, or another related field.
Current/active Certified Pharmacy Technician from the Pharmacy Technician Certification Board (PTCB).
Experience with EPIC. Experience with CoverMyMeds or other prior authorization process automation tools.
Knowledge of regulations and requirements for government agencies, insurance carriers, and pharmaceutical manufacturers as they relate to medication assistance programs.
Physical Requirements:
May sit, stand, stoop, bend, and ambulate intermittently during the day.
May need to sit or stand for extended periods.
See in the normal visual range with or without correction.
Hear in the normal audio range with or without correction.
Finger dexterity to operate office equipment required.
May need to lift up to twenty-five (25) pounds on occasion.
Ability to communicate in face-to-face, phone, email, and other communications.
Ability to see computer monitor and departmental documents.
Job Information
Job Category:
Administrative and Clerical
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