Medication Prior Authorization Specialist

Providence-Swedish-; Seattle (WA); On-site; USD 32,000 - 49,000; Full time

Benefits offered by this job

401k matching

Medical benefits

Paid time off

Job summary

Providence Swedish is seeking a Prior Authorization Specialist to facilitate processing of medication prior authorizations for clinic patients in accordance with guidelines. This role acts as a liaison among physicians, pharmacies, clinic staff and insurance carriers to ensure high-quality service.

Join a not-for-profit health care system committed to patient-centered care and collaborative teamwork. The position offers comprehensive benefits and opportunities to grow within Swedish Medical

Qualifications

• 2 years experience in a medical clinic or managed care/health insurance plan within the past 2 years.
• 2 years experience in an area such as prior authorizations, medical audits, appeals or delegation.
• 1 year Epic software experience.

Responsibilities

• Demonstrates proficiency in the core functions of one or more medication prior authorization areas, including prior authorizations, appeals, audits, and training.
• Serves as a resource for the Prior Authorization Service by providing technical assistance to clinic staff and physicians regarding patient coverage, authorization guidelines and procedures, claims research, and departmental operating procedures.
• Utilizes and navigates various insurance company websites to obtain medication prior authorization requirements and protocols.
• Receives, triages, and responds appropriately to phone calls from pharmacies and clinics seeking assistance.
• Processes all documentation and forms related to medication prior authorizations, including submissions via fax, online portals, and telephone.
• Verifies member eligibility as necessary to process medication prior authorizations and collaborates with clinic staff and pharmacies to obtain required information.
• Reviews patient charts to gather documentation supporting the medical necessity of requested medications. Completes prior authorization requests by incorporating relevant clinical information and benefit details, including plan limitations and exclusions, to support the medical review process.
• Contacts clinics to obtain additional clinical information, such as chart notes and diagnostic results, as needed to facilitate the medical review process.

Skills

Medical clinic exp

Prior authorizations

Communication skills

Education

Bachelor's degree

Tools

Epic software

Job description

Providence Swedish is seeking a Prior Authorization Specialist to facilitate processing of medication prior authorizations for clinic patients in accordance with guidelines. This role acts as a liaison among physicians, pharmacies, clinic staff and insurance carriers to ensure high-quality service.

Join a not-for-profit health care system committed to patient-centered care and collaborative teamwork. The position offers comprehensive benefits and opportunities to grow within Swedish Medical