What are the responsibilities and job description for the Prior Authorization Specialist position at M Health Fairview?
Responsibilities/Job Description
The Prior Authorization Specialist is responsible for verifying health insurance, obtaining benefits and meeting payer requirements to secure prior authorizations for medications. Verifies insurance coverage, resolves any issues with authorization and escalates complicated issues to appropriate manager. Prior Authorization Specialist acts as a liaison between patients, their health insurance, and care providers to assist in the understanding of their pharmacy benefit and responsibility.
Using strong knowledge of insurance, clinic operating procedures and pharmacy operations, this position will:
- Ensure timely response and initiation of prior authorization requests, consulting patient record and other resources as needed.
- Document patient information in the medical record using standard operating procedures and meeting appropriate timelines.
- Drive communication with clinic staff, patients, third party payers and dispensing pharmacy to provide exemplary customer experience and ensure all payer requirements are met
- Provide superior customer service to all internal and external customers.
- Serve as a prior authorization resource to the affiliations, staff and physicians regarding Fairview Pharmacy services. Assist with coordination of services by communicating effectively and in a timely manner with others.
- Other duties as assigned.
Organization Expectations, as applicable:
- Demonstrates ability to provide care or service adjusting approaches to reflect developmental level and cultural differences of population served
- Partners with patient care giver in care/decision making.
- Communicates in a respective manner.
- Ensures a safe, secure environment.
- Individualizes plan of care to meet patient needs.
- Modifies clinical interventions based on population served.
- Provides patient education based on as assessment of learning needs of patient/care giver.
- Fulfills all organizational requirements
- Completes all required learning relevant to the role
- Complies with and maintains knowledge of all relevant laws, regulation, policies, procedures and standards.
- Fosters a culture of improvement, efficiency and innovative thinking.
- Performs other duties as assigned
Required
Education:
Diploma or GED equivelant
Experience
One year of experience in a pharmacy setting or with revenue cycle, health insurance or benefits
Preferred
Experience
2 years of experience in a pharmacy setting or with revenue cycle, health insurance or benefit experience using ICD 10 Codes.
License/Certification/Registration
Registered Technician with Minnesota Board of Pharmacy
Qualifications
