Authorization Management Specialist (Specialty Pharmacy)

Hy-Vee Pharmacy Solutions; Omaha (NE); On-site; USD 26,000 - 28,000; Full time

Benefits offered by this job

Six paid holidays

Mon-Fri schedule 8am-5pm CST

Job summary

Amber Specialty Pharmacy is seeking an Authorization Management Specialist in the Operations department. The role involves preparing appeal summaries, prior authorizations, and communicating with providers, plans, and patients. The position is non-exempt and offers a Monday–Friday schedule with a daytime CST workday.

Wages range from $19.00 to $20.00 hourly with six paid holidays. Applicants must pass post-offer drug screening and background checks as required by policy and regulation.

Qualifications

• Working knowledge of the healthcare industry.
• HIPAA trained and/or the ability to protect highly confidential information.
• Six months or less of similar or related work experience.
• High school diploma or equivalent.

Responsibilities

• Initiates and completes prior authorizations and appeals for specialty pharmacy.
• Communicates with providers, health plans, PBMs, and patients to obtain status.
• Submits PA/appeal requests via electronic, phone, or fax on behalf of physicians.
• Maintains accuracy and timeliness of all authorization documents.
• Assists in reviewing patient charts and payer requirements.

Skills

MS Excel

MS Word

MS Outlook

Insurance verification

Communication skills

Timely deadlines

Interpersonal skills

Medicare/Medicaid knowledge

PAP/PA experience

Reading handwriting in records

Education

High school diploma or equivalent

Pharmacy Technician Certification

Tools

Microsoft Outlook

Skype

EMR systems

Job description

Additional Considerations (if any)

At Amber Specialty Pharmacy, our commitment to patient care is unmatched. Enjoy fulfillment in a career where you have the opportunity to make a positive impact on patients with complex and chronic conditions.

Monday-Friday (no weekends) Hours: 8 a.m. - 5 p.m. CST Wages: Hourly $19.00 to $20.00 Six paid holidays Must pass post-offer, pre-employment drug background tests as allowed by state, federal, local ordinance, statutes and licensing/accreditation requirements.

Job Title and Department

Amber Specialty Pharmacy Job Title: Authorization Management Specialist Department: Operations FLSA: Non-Exempt General Function

Responsible for preparing appeal summaries and prior authorizations, correspondence with prescriber's offices, and documenting information in the electronic medical record. Gathers pertinent patient history and information, evaluates information, prepares responses, and completes appeals and prior authorizations accurately and timely.

Reporting Relations

Reports to: Authorization Management Specialist, Lead

Direct Reports: None

Primary Duties and Responsibilities

• Initiates and completes prior authorizations and appeals for specialty pharmacy
• Work directly with providers, health plans, PBMs, and other specialty pharmacies to relay vital information and provide a high level of service
• Communicates with providers, health plans, PBMs, and patients to obtain the status of pending prior authorizations and appeals
• Submits prior authorization and/or appeal requests via electronic, phone, or fax on behalf of physicians/providers as allowed
• Assures that all prior authorization and appeal documents, databases, and records are maintained accurately and timely
• Evaluate and process claims rejected for prior authorization following company policies and procedures
• Advocates on the patient's behalf to identify and assess coverage issues
• Assists licensed professionals in reviewing patient chart notes and payer requirements to determine why cases are an appropriate course of action
• Assures timeliness and appropriateness of all PA requests and provider appeals according to state, federal, and company guidelines
• Adheres to all company policies as indicated in the handbook and directives issued by management.
• Has reviewed Accreditation Policy and Procedure manual

Professional Competencies

• Proficient with MS Excel, Word, and Outlook
• Understanding of insurance verification and online prescription adjudication
• Strong oral, written, and interpersonal skills
• Self-initiative
• Demonstrated ability to meet tight deadlines
• Ability to work with all levels of internal management and staff, as well as outside clients and vendors
• Working knowledge of Medicare, Medicaid, Commercial Insurance, and renal programs related to pharmacy, billing, grants, co-pay cards, prior authorizations, and rejections
• Prior PAP, PA, and co-pay card experience preferred
• Previous experience troubleshooting rejected pharmacy claims preferred
• Proficiently read and understand abstract information from handwritten patient medical records

Required Qualifications

• Working knowledge of the healthcare industry
• HIPPA trained and/or the ability to work with and protect highly confidential patient and employee information
• Six months or less of similar or related work experience
• High school diploma or equivalent

Licensure and Certification Requirement

Nationally Certified Pharmacy Technicians preferred Application for certification within state-specified criteria

Physical Requirements

Must be able to remain in a stationary position up to 90% of the time. The person in this position must occasionally move inside the office to access file cabinets, machinery, etc., and traverse conferences, meetings, and remote events. Constantly operates a computer and other office productivity machinery, such as a calculator, copy machine, and computer printer. The ability to communicate information and ideas so others will understand. Must be able to exchange accurate information in these situations. The ability to observe details at close range (within a few feet of the observer).

Working Conditions

Normal office environment.

Equipment Used to Perform the Job

Computers, keyboards, mouse, monitors, fax, and/or headsets for phone work. Software specific to the position, including but not limited to Microsoft Outlook and Skype. Must lift and traverse the area to move paper and supplies to use the equipment.

Contacts

Frequently interact with co-workers, intradepartmental staff of the Company, managers, leaders, insurance providers, payers, vendors, and customers. This is not an exhaustive list of contacts and is subject to changes and alternatives.

Confidentiality

The incumbent must maintain the confidentiality of personal information for the applications and licensing requirements, including any financial, strategic, or proprietary information. The Company does not consider this an exhaustive list of examples and may add or modify as deemed appropriate to the execution of the role.

Candidates must be able to pass a pre-employment drug test, background check, and health screening (if applicable).

About Amber Specialty Pharmacy

Join Amber Specialty Pharmacy, where independent thinking and individualized care are the cornerstones of our dynamic approach in the specialty pharmacy and infusion services industry. As a wholly owned subsidiary of Hy-Vee, Inc., we stand at the forefront of healthcare innovation, headquartered in Omaha and serving patients nationwide. Our commitment to exceptional patient care is unparalleled. We specialize in managing rare and chronic conditions, in categories like organ transplant, oncology, and more. With unwavering dedication, we provide comprehensive clinical support and patient management, ensuring each individual's unique needs are met. What sets us apart is our commitment to core family values. At Amber Specialty Pharmacy, we uphold a tradition of respect and dignity for both patients and employees alike. Our passionate team delivers specialized care with honesty and compassion, making a positive impact on the lives we touch. If you're seeking a fulfilling career that aligns with your values and allows you to make a meaningful difference in the lives of patients, join us at Amber Specialty Pharmacy. Together, we'll continue our legacy of exceptional care and innovation.