PRIOR AUTHORIZATION SPECIALIST (PHARMACY TECHNICIAN)

In general, a Pre-Authorization Coordinator will be responsible for the following tasks:

i. Gather ALL necessary information and supporting documents to comply with MCO requests in order to promptly determine treatment Authorization or Denial.

ii. Contact insurance companies or other payers to complete prior authorization requirements, identify the co-payment structure and investigate coverage and benefits;

iii. Communicating with patients to inform co-pay/deductible amount. and informing about Alivia’s Patient Assistance Programs (PAP). Referring to PAP, as appropriate.

iv. Conduct benefit coordination on behalf of patients, when applicable

v. Determine patient eligibility

vi. Request authorization modifications, as needed.

vii. Index documents in patients’ records in a timely manner

viii. Respond to incoming calls with excellent customer service standards and following up with pending tasks (internal or external);

ix. Meet management’s production standards, whether quantitative or qualitative

Other duties: Perform or assist with any operation, as necessary to maintain the workflow and to comply with schedules and quality requirements; Participate in meetings and work groups prepared by management or co-workers. Be knowledge related to new developments, requirements and policies. The P-AC’s goal is to ensure patient satisfaction through personal attention, and an efficient, transparent and simple process from end to end.

The P-AC must tend to the Patient’s needs, questions and concerns with kindness and awareness of their circumstances. As part of said tasks, the P-AC from time to time may have to also communicate with Doctors (Prescribers), Managed Care Organizations (MCO’s) and authorized caregivers. Attention to precision, compliance with industry standards and efficiency are essential for the safety and care of the patient, working within the limits of standard practice or accepted in a fast-paced Specialty Pharmacy.

Perform work assignments in full compliance with and understanding of state and federal laws, as well as the internal policies and procedures that govern the handling, dispensing and distribution of controlled substances.

Minimum Requirements:

• Experience working with pre authorization processes or health plans is preferred.
• Associate Degree Diploma with valid license as Pharmacy Technician is required.
• Minimum 1-year experience in customer service with knowledge of access processes to the most preferred benefits.

***Equal Opportunity Employer F/M/D/V***