Prior Authorization Specialist

Come launch the next step in your career where America launched its Space Program. Brevard Health Alliance, Brevard County’s only Federally Qualified Health Center, is currently recruiting for a Prior Authorization Specialist to join us in the heart of Brevard County’s Space Coast. Since 2005 our focus has been on putting the “community” in Community Health while delivering healthcare to more than 60,000 unique patients annually.

Brevard Health Alliance offers competitive salaries, a comprehensive hiring package that includes Medical, Dental, Vision, Short and Long-term Disability Coverage and a 401K with company match, a generous personal leave program, a National Health Service Corps (NHSC) Approved Site for Loan Repayment and Qualified Employer for Public Service Loan Forgiveness, tuition assistance for continuing education, professional development, and the opportunity for upward mobility.

We are expanding, we are growing. If you would like the genuine opportunity to make a profound difference in the delivery of primary care and community health, we invite your interest and application after reviewing the specifics and requirements for the Prior Authorization Specialist listed below.

POSITION SUMMARY

This position plays a vital role in assisting the medical and Pharmacy departments by facilitating the prescription prior authorization process. A Pharmacy PA Specialist will navigate the pre-approval process with insurance companies and work with the providers and patients to expedite the authorization process and reduce delays in accessing needed medications. This role involves patient interaction, as well as acting as a liaison and educator to provide guidance and support regarding the PA process.

GENERAL EDUCATION REQUIREMENTS

• High School Diploma or General Equivalency/Educational Diploma (GED)
• Knowledge of pharmaceuticals, medical terminology and prior authorization process
• Medical Assistant or Pharmacy Technician certification preferred
• One year previous experience with medication prior authorization preferred

ADDITIONAL QUALIFICATIONS

• Current BLS/CPR certification from the American Heart Association or the American Red Cross
• Knowledge of medical terminology, Health Insurance Portability and Accountability Act (HIPAA) compliance and basic clinical exam procedures
• Proficient using an Electronic Medical Record and other relevant software and systems
• Strong communication and interpersonal skills to effectively liaise with patients, providers and insurance companies
• Excellent organizational skills
• Attention to detail and accuracy in completing PA form and related paperwork
• Ability to work independently and collaboratively in as fast paced environment

PRIMARY ACCOUNTABILITIES

Primary Accountabilities of the PA Specialist include, but are not limited to the following:

• Prior Authorization Process Management: Review prescription orders to identify medications requiring prior authorization. Initiate prior authorization by collecting and verifying patient information and medical history. Collaborate with healthcare providers and insurance companies to submit accurate requests. Ensure completed forms and documentation are attached.
• Patient Liaison/Educator: Assist patients with the prior authorization process. Educate patients on its importance and potential outcomes. Address patient concerns and coordinate with healthcare providers as needed.
• Clinic Chats Management: Conduct real-time chats to resolve prior authorization queries. Collaborate with the healthcare team for seamless communication. Maintain records and follow up on action items.
• Documentation and Compliance: Keep detailed records of prior authorization activities.
• Comply with pharmacy industry regulations and data protection protocols.
• Quality Assurance and Process Improvement: Participate in quality assurance initiatives. Provide feedback to optimize the prior authorization workflow.
• Stay updated on insurance policies and industry developments.
• Other duties as assigned.