Medication Access Coordinator I

geisinger; United States; Remote; USD 60,000 - 75,000; Full time

Job summary

Geisinger is seeking a Work from Home (PA) Authorization Specialist to obtain prior authorizations, complete benefit investigations, and act as a liaison for payers, departments, and patients. Serves as subject matter expert for patient assistance foundations and reimbursement methodologies.

Key duties include researching payer criteria, documenting referrals, informing the care team of authorization status, and educating providers on specialty services to improve patient care.

Qualifications

• Experience with prior authorization processes.
• Knowledge of third-party payer criteria and benefit investigations.
• Ability to navigate insurance requirements and reimbursement policies.

Responsibilities

• Completes prior authorization and documents referrals for all medications reviewed using appropriate third-party payer criteria.
• Conducts research and follow-up activities within established timeframes, keeping up with payer criteria changes.
• Communicates with care team to provide status on authorization.
• Maintains knowledge of patient assistance programs and eligibility requirements.
• Identifies suitable medication assistance programs based on affordability and patient need.
• Ensures signatures for enrollment in assistance programs are completed correctly.

Skills

Communication

Computer Literacy

Customer Service

Healthcare Industry

Medical Terminology

Education

High School Diploma or GED

Job description

Location: Work from home (Pennsylvania)

Shift: Days (United States of America)

Scheduled Weekly Hours: 40

Worker Type: Regular

Exemption Status: No

Job Summary

"PA Residents Only" Accountable to obtain prior authorization for medications. Complete benefit investigation to determine coverage for prescribed treatment and act as a liaison for all medication prior authorization matters to insurance companies, departments, and patients. Act as subject matter expert for patient medication assistance foundations, free drug and drug replacement programs for uninsured, under-insured, indigent population. Maintains updated knowledge of pharmacy reimbursement methodologies.

Job Duties

• Completes prior authorization and documents referrals for all medications reviewed using appropriate third-party payer criteria.
• Conducts research and follow-up activities within established timeframes. Maintains knowledge of criteria changes of third-party payor authorization requirements.
• Communicates with care team to provide details on authorization status.
• Maintains knowledge of all available patient assistance programs and eligibility requirements.
• Identifies available appropriate medication assistance programs upon discussing with patient the affordability of the prescribed treatment.
• Ensures accurate completion necessary signatures of appropriate paperwork for enrollment in assistance program(s).
• Tracks fund award end dates and exhaustion, re-apply as necessary to avoid lapse in therapies.
• Communicates with care team to provide details on status of assistance applications.
• Educate providers and patients on specialty services and how this improves overall patient care. Grow the specialty pharmacy's patient population.
• Floats from areas of low workload to areas of heavy workload as needed to provide optional patient services.
• Accountable for satisfying all job specific obligations and complying with all organization policies and procedures.

Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.

*Relevant experience may be a combination of related work experience and degree obtained (Associate's Degree = 2 years; Bachelor's Degree = 4 years).

Position Details

Education

High School Diploma or Equivalent (GED)- (Required)

Experience

Minimum of 6 years-Relevant experience* (Required)

Skills

• Communication
• Computer Literacy
• Customer Service
• Healthcare Industry
• Medical Terminology

OUR PURPOSE & VALUES

Everything we do is about caring for our patients, our members, our Geisinger family and our communities.

KINDNESS

We strive to treat everyone as we would hope to be treated ourselves.

EXCELLENCE

We treasure colleagues who humbly strive for excellence.

LEARNING

We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow.

INNOVATION :

We constantly seek new and better ways to care for our patients, our members, our community, and the nation.

SAFETY:

We provide a safe environment for our patients and members and the Geisinger family.

We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, we encourage an atmosphere of collaboration, cooperation and collegiality.

Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws.