Pharmacy Authorization Specialist - Prior Auth & Denials

OneOncology; Shirley (NY); Sur place; USD 50 000 - 75 000; Plein temps

Résumé du poste

New York Cancer & Blood Specialists (NYCBS) in New York is seeking a Pharmacy Authorization Specialist to manage prior authorizations, drug orders, and denials within OncoEMR. You will coordinate with onsite pharmacy, insurance companies, and patients to keep approvals moving.

The role requires high school or GED, experience in pharmacy authorization, and proficiency with EMR and Microsoft Office. You will document steps, prepare appeals, and protect confidentiality while providing calm, clear

Qualifications

• High school or GED required.
• Experience in pharmacy/authorization field.
• Healthcare experience, preferably clinical or business office.
• Experience with insurance requirements and ICD-10/CPT coding.
• Experience in billing/practice management systems and MS Word/Excel.
• Excellent verbal and written communication with various stakeholders.
• Ability to multitask, problem-solve, and follow complex instructions.
• Calm, friendly, and patient-centered communication.
• Able to support patients during difficult times.

Responsabilités

• Run daily Business Office Report in OncoEMR for drug order values and POD verification.
• Process CBS Pharm Fill for current date and one week out, securing prior authorizations. Address STAT orders immediately.
• Handle daily requests from onsite pharmacy dispensaries to obtain prior auth on requested medication.
• Document notes in the Sig Box of OncoEMR within the patient’s treatment plan, including approval status.
• Prepare appeals for denials on prior authorization requests as applicable.
• Refer denied prescription fill requests or those with patient financial responsibility to the pharmacy financial counselor.
• Verify patient’s own drug with pharmacy-related queries; notify Nursing Management of changes to BB or Buy/Bill.
• Handle prior authorization requests from local pharmacies for oral medications or specialty drugs.
• Maintain confidentiality of all patient and employee information; overtime may be required with notice.

Connaissances

Verbal communication

Interpersonal skills

OncoEMR

Microsoft Word

Microsoft Excel

Formation

High School diploma or GED

Outils

OncoEMR

EMR systems

Description du poste

New York Cancer & Blood Specialists (NYCBS) in New York is seeking a Pharmacy Authorization Specialist to manage prior authorizations, drug orders, and denials within OncoEMR. You will coordinate with onsite pharmacy, insurance companies, and patients to keep approvals moving.

The role requires high school or GED, experience in pharmacy authorization, and proficiency with EMR and Microsoft Office. You will document steps, prepare appeals, and protect confidentiality while providing calm, clear