Chemotherapy Authorization Specialist

The US Oncology Network; Newport News (VA); On-site; USD 45,000 - 60,000; Full time

Job summary

A leading oncology care provider in Newport News is seeking a Pharmacy Tech Authorization Specialist. This role involves dispensing oral medications, obtaining insurance authorizations, and ensuring patients receive timely access to medications. Candidates should have a high school diploma, 3-5 years of experience in retail pharmacy, and certification as a Pharmacy Technician. Strong communication skills and knowledge of insurance processes are essential. The position may require travel to different office locations.

Qualifications

• Minimum 3-5 years of experience in a retail pharmacy setting.
• Certified Pharmacy Technician certification required.
• Preferred two years in medical insurance verification and coding.

Responsibilities

• Provide in-office dispensing of oral drugs to oncology patients.
• Obtain insurance authorizations for oral medications.
• Maintain confidentiality and comply with regulations.

Skills

Patient communication

Insurance verification

Independent work

Inventory control

Education

High School diploma or equivalent

Tools

Prior authorization portals

Patient assistance programs

Job description

Overview

Virginia Oncology Associates, the largest group of medical professionals in Hampton Roads and Northeast North Carolina devoted exclusively to cancer care and blood disorders, has an exciting opportunity for a Pharmacy Tech Authorization Specialist for our offices in Newport News.

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Responsibilities

Under the supervision of a physician/pharmacist, provide in-office dispensing of oral drugs to oncology and hematology patients. This includes technical aspects of oral medication dispensing, record keeping and inventory control. Also, the tech will obtain insurance authorizations for oral medication, research additional or alternate resources for patient financial assistance, and research denied services to ensure patients receive medications on a timely basis.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Verifies patient demographics, insurance information and prescription information
• Processes prescription and bills insurance for payment
• Troubleshoots Medicare Part B verification requirements
• Demonstrates the ability to work independently and in a timely manner. Communicate efficiently with patients and providers to ensure access barriers are overcome.
• Obtains insurance prior authorizations for oral chemo drugs and retail pharmacy drugs
• Applies for financial assistance through cancer foundations, patient assistance programs and co-pay assistance for non-covered or high dollar oral drugs
• Communicates with medical staff to inform them of any restrictions or special requirements with insurance plans, and documentation or payer issues with non-covered chemotherapy drugs; reports any problems or payer trends
• Processes insurance/patient correspondence, including denial follow-up, and maintains reimbursement correspondence and filing systems
• Acts as patient advocate and functions as liaison between the patient, payer, specialty pharmacy, and patient assistant programs
• Counsels patients on insurance benefits and copayments. Refers appropriate patients to patient assistance programs
• Maintains a good working knowledge of chemotherapy authorization requirements for all payers, as well as state and federal regulatory guidelines for coverage and authorization
• Maintains beneficial relationships with specialty pharmacy contacts, drug reps and patient assistance programs
• Requires use of prior auth, specialty, and patient assistance portals
• Will be cross-trained to cover other retail/dispensary pharmacy technicians when needed
• Complies with patient confidentiality laws and regulations

Qualifications

• High School diploma or equivalent.
• Minimum 3-5 years of experience in a retail pharmacy setting.
• Certified Pharmacy Technician certificate or State Pharmacy Board required.
• Minimum two (2) years medical insurance verification/authorization and billing/coding experience preferred.
• Must be willing to travel to other office locations if needed.

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations and other conditions common to an oncology/hematology clinic environment. While performing the duties of this job, the employee is regularly exposed to direct contact with patients with potential for exposure to toxic substances, medicinal preparations, and chemotherapeutic agents.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Requires full range of body motion including handling and lifting patients, manual and finger dexterity, and eye-hand coordination. Requires standing and walking for extensive periods of time. Occasionally lifts and carries items weighing up to 40 lbs. Requires corrected vision and hearing to normal range.