pharmacy Authorization Specialist (pharmacy Tech):
Universal Health Services

1558890616
Universal Health Services
Reno Nevada
Biotech
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Description
Responsibilities

Job Summary:

The Pharmacy Authorization Specialist (Pharmacy Technician) serves as the coordinator between Prominence Health Plan, its members, and contracted providers for the prior authorization review process. The main focus of this position is preparing and loading prior authorizations for injectable drugs. This includes ensuring proper diagnosis and billing codes are input and verifying the accuracy of the dose and frequency of submitted requests. In addition, this individual will perform provider outreach to obtain sufficient documentation for coverage determinations as necessary. We are looking for someone with an understanding of medical drug billing and a background that includes interpreting clinic notes and/or drug orders. By performing these duties, the Pharmacy Authorization Specialist will coordinate an effective and efficient review process, improving the internal workflow of the pharmacy team and increasing member and provider satisfaction with our prior authorization review process.

Qualifications

Duties and Responsibilities:

* Understands medical drug orders and the drug billing process
* Provides excellent customer service by consistently meeting and exceeding customer service standards.
* Accurately loads authorization requests, including diagnosis codes, billing codes, and dose strength and frequencies
* Able to prioritize requests to meet CMS timeliness standards for prior authorizations
* Collaborate with the Pharmacy Department and receive direction from the Pharmacists to improve the prior authorization and quality metrics
* Develops best practices for provider outreach
* Responsible for maintaining productivity standards and tracking performance
* Contributes to overall department strategy through insight and experience
* Collaborates with Utilization Management and Medical Directors to ensure continuity of service between departments
* Helps develop reports to assess utilization management strategies and effectiveness
* Works effectively within the pharmacy team and interdepartmental teams
* Collects and tracks performance metrics and leads by example to others
* Documents conversations with provider offices in outreach activities.
* Communicates effectively in word and in writing
* Performs other duties as required

Qualifications and Requirements:

* High School diploma or equivalent
* Current and valid state licensure as a pharmacy technician is required
* 3+ years in hospital or retail pharmacy is preferred

Language Skills:

* Ability to effectively communicate in English, both verbally and in writing.
* Knowledge of medical terminology
* Exceptional customer service skills, interfacing between the health plan and providers' offices

Skills:

* Understanding of the medical drug billing process
* Proficient in Microsoft Office
* Enjoys working in both individual and team settings
* Comfortable calculating doses and frequencies for medication treatment regimens
* Self-starter, resourceful and able to execute projects in a fluid and fast paced environment
* Strong analytical skills
* Knowledge of the purpose and process of prior authorizations
* Attention to detail and accuracy
* Ability to utilize technology and work within multiple software programs
* Understanding of health plan departments and functional areas for problem resolution
* Comfortable collecting and tracking performance metrics and reports

Physical Demands:

* For physical demands of position, including vision, hearing, repetitive motion and environment, see following description.