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Pharmacy Prior Authorization Agent
Location
CST (UTC-6)
Posted
3 days ago
Salary
$23 - $36 / hour
Seniority
Mid Level
No structured requirement data.
Job Description
Pharmacy Prior Authorization Agent
American Addiction Centers
Role Description - Complete insurance verification and eligibility checks. - Collect and accurately document initial pre-certification/authorization information if available. - Initiate the process of obtaining a required referral/authorization if not obtained. - Work assigned Epic work queue, following the department’s workflow process on appropriately transferring, deferring, or removing orders from the work queue. - Proactively communicate issues involving customer service and process improvement opportunities to management. - Maintain excellent public relations with patients, patients’ families, and clinical staff. - Demonstrate a willingness and ability to work collaboratively with others for concise and timely flow of information. - Maintain knowledge of Medicare, Medicaid, and third-party payer requirements, guidelines, and policies. - Update the patient, physician's office, and any necessary parties regarding responses and outcomes of prior authorizations. - Act as a liaison between physician's office, patient, and pharmacy benefit manager to initiate and resolve appeals, as needed. - Identify and assist patients with access to internal and external financial assistance programs. - Communicate to the patient and/or physician's office when authorization is not obtained or services are not covered, and explain the potential financial responsibility. - Coordinate with patient, clinical team, and assistance programs to secure reimbursement or alternative covered options. - Manage incoming and outgoing calls, which may include other Advocate team members, departments, patients, insurance plans, and/or copay foundation/assistance programs. Qualifications - High School Graduate Requirements - Typically requires 1 year of experience in health care, insurance industry, pharmacy, or medical background. - Demonstrate ability to identify and understand issues and problems. - Ability to problem solve in a high profile and high stress area. - Mathematical aptitude, effective communication, and critical thinking skills. - Ability to prioritize and organize workload. - Excellent verbal and written communication skills. - Demonstrated technical proficiency including experience with insurance authorization/eligibility tools, EPIC, Microsoft Office, Internet browser, and telephony systems. Benefits - Paid Time Off programs. - Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability. - Flexible Spending Accounts for eligible health care and dependent care expenses. - Family benefits such as adoption assistance and paid parental leave. - Defined contribution retirement plans with employer match and other financial wellness programs. - Educational Assistance Program. - Compensation based on qualifications, skills, relevant experience, and/or training. - Premium pay such as shift, on call, and more based on a teammate's job. - Incentive pay for select positions. - Opportunity for annual increases based on performance.
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