Pharmacy Preauth Specialist — Drive Access & Reimbursement

The MetroHealth System; Valley View (OH); On-site; USD 55,000 - 75,000; Full time

Job summary

The MetroHealth System in Valley View, OH is seeking a Pharmacy Preauth Specialist to process and obtain authorizations for medication therapy requests within the Specialty Pharmacy. This role acts as the main contact for benefits verification and payor preauthorization, coordinating with patients and program representatives.

Your responsibilities include following up on authorizations, applying denial management protocols, and supporting programs that reduce drug costs for uninsured patients.

Qualifications

• Associate’s Degree in Healthcare, Business Administration, or related field or equivalent experience.
• 1 year of pharmacy dispensing in a hospital setting or 2 years in retail pharmacy; or 2 years in hospital billing/reimbursement.
• Knowledge of pharmaceutical reimbursement requirements and best practices.
• Proficient in MS Office; strong communication and customer service skills.

Responsibilities

• Process and obtain authorizations for medication therapy requests initiated by clinicians for the Specialty Pharmacy.
• Serve as primary contact for benefits verifications and payor preauthorization; liaison between patients and assistance programs.
• Follow up on authorizations and implement denial management protocols.
• Coordinate with pharmacy services, physicians, social work, and patients on preauthorization and assistance programs.
• Ensure compliance with Federal and State regulatory requirements.

Skills

Customer service

Communication

Analytical thinking

Medical terminology

Independent worker

Education

Associate’s Degree in Healthcare/Business

Certified Pharmacy Technician (PTCB)

Bachelor’s degree (preferred)

Tools

EPIC

CoverMyMeds

Microsoft Office (Excel/Word)

Job description

The MetroHealth System in Valley View, OH is seeking a Pharmacy Preauth Specialist to process and obtain authorizations for medication therapy requests within the Specialty Pharmacy. This role acts as the main contact for benefits verification and payor preauthorization, coordinating with patients and program representatives.

Your responsibilities include following up on authorizations, applying denial management protocols, and supporting programs that reduce drug costs for uninsured patients.