What are the responsibilities and job description for the Pharmacy Prior Authorization Specialist position at CareMed Specialty Pharmacy?
Seeking Pharmacy Prior Authorization Specialist with experience! Pharmacy Prior Authorization Specialist needed in New Hyde Park, NY! CareMed Specialty Pharmacy is seeking candidates who live local to this pharmacy location. Full-time position Monday to Friday, daytime shifts. 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 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.
Salary Starting at $25.00 per hour and up.
We offer a variety of benefits including:
- Medical; Dental; Vision
- 401k with a match
- Paid Time Off and Paid Holidays
- Tuition Reimbursement
- Company paid benefits – life; and short and long-term disability
The Prior Authorization Specialist will work from the prior authorization queue to resolve prior authorization and related insurance rejections. Prior authorization specialists will initiate prior authorizations, complete prior authorization forms via webtools such as CoverMyMeds or insurance specific forms including clinical information from clinical notes provided by prescribers, adjudicate test or live claims to review rejections, and follow up on PA requests with insurance companies, while taking prescriber preferences into account.
Pharmacy Prior Authorization Specialist Primary Responsibilities:
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Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests.
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Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding prior authorization information.
- Runs test claims or live claims to check for payable claims or for valid insurance rejections on medications that require prior authorizations and initiate Prior Authorization requests, using appropriate insurance forms or CoverMyMeds. Reviews accuracy and completeness of information and ensure supporting clinical documentation is included if required.
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Contacts insurance companies to follow up on prior authorization requests, including determining if any additional information is needed, or whether the claim is in review, approved, or denied. Document all prior authorization information in patient profile.
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Facilitates process for requesting and follow up of prior authorizations with prescribers through preferred contact methods noted in prescriber/patient profiles.
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Provides guidance to providers and patients in connection with documentation required for payer coverage, support with appeals for denied claims, and follow up with payer to determine outcome..
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Maintain a safe and clean pharmacy by complying with procedures, rules, and regulations and compliance with professional practice and patient confidentiality laws.
- Contributes to team effort by accomplishing related tasks as needed and other duties as assigned.
Pharmacy Prior Authorization Specialist 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
- Basic math and analytical skills
- Intermediate typing/keyboarding skills
Education/Learning Experience
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Required: High School Diploma or GED. Previous Experience in Pharmacy and Prior AuthorizationsDesired: 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
- Desired: Certified Pharmacy Technician (PTCB)
Behavior Competencies
- 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
Company Values: Teamwork, Respect, Integrity, Passion
Salary : $25
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