What are the responsibilities and job description for the Medication Prior Authorization Specialist position at Advocate Aurora Health?
Major Responsibilities:
Licensure, Registration, and/or Certification Required:
Education Required:
Experience Required:
Knowledge, Skills & Abilities Required:
Physical Requirements and Working Conditions:
This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.
- Ability to complete insurance verification and eligibility checks.
- Ability to collect and accurately document initial pre-certification/authorization information if available. Initiates the process for obtaining a required referral/authorization if not obtained.
- Ability to work assigned Epic work queue, following the department’s workflow process on appropriately transferring, deferring, or removing orders from the work queue.
- Ability to proactively communicate issues involving customer service and process improvement opportunities to management.
- Maintains excellent public relations with patients, patient's families and clinical staff as well as demonstrates a willingness and ability to work collaboratively with others for concise and timely flow of information.
- Maintains knowledge of and reference materials for Medicare, Medicaid and third-party payer requirements guidelines and policies, insurance plans requiring pre-authorization/referral and a list of current accepted insurance plans.
- Ability to update the patient, physician's office, and any necessary parties, through multiple methods as appropriate (including telephone, in-basket messaging, and electronic medical record), regarding responses and outcomes of the prior authorizations.
- Ability to act as a liaison between physician's office, patient, and pharmacy benefit manager to initiate and resolve appeals, as needed.
Licensure, Registration, and/or Certification Required:
- None Required.
Education Required:
- High School Graduate.
Experience Required:
- Typically requires 1 year of experience in health care, insurance industry, pharmacy, or medical background.
Knowledge, Skills & Abilities Required:
- Demonstrated ability to identify and understand issues and problems. Examines data and draws logical conclusions based on information available.
- Knowledge and ability to articulate explanations of Medicare/HIPAA/EMTALA rules and regulations and comply with updates on insurance pre-certification requirements.
- Mathematical aptitude, effective communication skills and critical thinking skills.
- Understanding of basic human anatomy, medical terminology and procedures for application in the patient referral/pre certification/authorization processes.
- Ability to speak effectively to customers or employees of the organization, maintaining a pleasant, professional demeanor.
- Ability to handle sensitive and confidential information according to internal policies.
- Ability to problem solve in a high profile and high stress area, working independently to set and meet deadlines and prioritize work.
- Demonstrated technical proficiency including experience with insurance verification/eligibility tools, Epic electronic medical record, patient liability estimation tools, Microsoft Office, Internet Explorer and phone technology.
Physical Requirements and Working Conditions:
- Must be able to sit majority of the workday
- Occasionally lifts up to 10 lbs.
- Operates all equipment necessary to perform the job.
This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.
