Insurance Authorization Specialist - Pharmacy Outpatient

Penn State Health Milton S. Hershey Medical Center

 

Location:  US:PA:Hershey

Work Type:  Full Time

FTE: 1.0

Shift:  Varied
Hours:  Varied

 

JOB SUMMARY:

 

Researches, obtains authorizations, insurance verifications, clinical documentation, prescription information and financial ability information needed to ensure when a prescriber writes a Specialty (high price, high risk and high touch) medication, so that the patient is able to initiate therapy in a timely and cost efficient manner.

ESSENTIAL FUNCTIONS:

·         The percentage of time spent performing essential functions is 95%. Qualified individuals must have

·         The ability (with or without reasonable accommodation) to perform the following duties:

·         Find patient pharmacy benefit information.

·         Enter pharmacy benefit information applicable systems.

·         Run prescription to identify coverage and cost. If denied, complete prior authorization to insurance company. If approved, run prescription, determine copay and contact patient to notify of cost and status and to set up delivery.

·         If patient cannot afford the medication, initiate referral to Prescription Assistance Program or enroll patient with manufacturer copay assistance card. If denied, request rationale on an appeal and then prepare and submit the appeal.

·         Complete all applicable steps, such as prior authorization activity, referral manager activity, onboarding activity, PCC initial activity, refill activity and scanning of all documents into applicable systems.

·         Communicate through each step of the process to the provider teams.

·         Set up peer to peer with provider and insurance, if needed.

·         Follow up daily with all pending PAP, denials, appeals and prior authorizations still in pending status.

NON-ESSENTIAL FUNCTIONS:

·         The percentage of time spent performing secondary functions is 5%. The following duties are considered secondary to the essential duties listed above:

·         Attend meetings.

MINIMUM QUALIFICATIONS:

·         High School Diploma or equivalent required.

·         Two (2) years of experience in Prior Authorizations in either a Pharmacy or a Clinical setting required.

·         KNOWLEDGE, SKILLS, & ABILITIES:

·         Ability to understand and analyze lab and clinical data within the patient’s EMR.

·         Ability to understand third party payer and insurance complexities.

·         Ability to communicate professionally with all patients, peers, providers.

·         Ability to train new hires.

·         Ability to multitask due to the high volume of phone calls.

·         Ability to know and understand complex therapies.

PREFERRED QUALIFICATIONS:

·         Pharmacy technician or Pharmacy billing experience with Insurers and Third Party payers preferred

 

 

 

If chosen for this position, you may be required to pass a Post Offer Employment Physical Exam in accordance with the measurements listed in the Work Task Analysis (WTA) report.  This job description is a general outline of duties performed and is not to be misconstrued as encompassing all duties performed within the position.  All individuals (including current employees) selected for a position will undergo a background check appropriate for the position's responsibilities.

 

Penn State Health is fundamentally committed to the diversity of our faculty and staff. We believe diversity is unapologetically expressing itself through every person's perspectives and lived experiences. We are an equal opportunity and affirmative action employer. All qualified applicants will receive consideration for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, race, religion, sex (including pregnancy), sexual orientation, veteran status, and family medical or genetic information. If you are unable to use our online application process due to an impairment or disability, please call 717-531-8440 between the hours of 8:30 AM and 4:30 PM, Eastern Standard Time, Monday – Friday, email hrsolutions@pennstatehealth.psu.edu or download our Accommodation Instructions for Job Applicants PDF for more detailed steps for assistance.

 

Union: Non Bargained