Pharmacy Prior Authorization and Billing Specialist

ProMedica; Toledo (OH); On-site; USD 42,000 - 56,000; Full time

Job summary

ProMedica is seeking a Pharmacy Prior Authorization and Billing Specialist in Toledo for the Pharmacy department. The role involves handling prior authorizations for medications through medical or pharmacy benefits, and collaborating with providers and pharmacies to resolve authorizations and denials.

The position requires an Associate degree or Certified Pharmacy Technician credential, plus extensive experience in billing/revenue cycle, ICD-10, and CPT coding.

Qualifications

• Associate degree or certified pharmacy technician credential, with relevant healthcare billing experience.
• Experience with ICD-10 and CPT coding for services.
• Minimum 5 years in medical office, retail pharmacy, or revenue cycle related roles.

Responsibilities

• Process medication prior authorizations for medical or pharmacy benefits.
• Communicate with providers and pharmacies to resolve authorizations and denials.
• Assist patients without adequate coverage with financial assistance options.

Skills

Billing/Insurance Verification

ICD-10 and CPT codes

Pharmacy Technician Certification

Education

Associate degree in related field

Job description

Location:

Toledo Hospital

Department:

Pharmacy

Weekly Hours:

40

Status:

Full time

Shift:

Days (United States of America)

Job Summary:

As a Pharmacy Prior Authorization and Billing Specialist, you will perform prior authorizations for medications through medical or pharmacy benefits as determined by the medication and payer, collaborate and communicate with providers and pharmacies to provide timely resolution of authorizations and denials, and may assist in securing patient financial assistance for patients who are under-insured or uninsured.

REQUIRED QUALIFICATIONS

• Associate degree in related field OR Certified Pharmacy Tech OR 5 years of Billing/Insurance Verification experience.
• Familiarity with ICD-10 and CPT codes applicable to services rendered.
• 5 years of relatable experience in a medical office, retail pharmacy, drug claims processing, or revenue cycle.

PREFERRED QUALIFICATIONS

• Specific knowledge of medication prior authorization process.

The above list of accountabilities is intended to describe the general nature and level of work performed by the positions; it should not be considered exhaustive.

Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression,age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or other status protected by applicable law.

ProMedica is a mission-driven, not-for-profit health care organization headquartered in Toledo, Ohio. It serves communities across nine states and provides a range of services, including acute and ambulatory care, a dental plan, and academic business lines. ProMedica owns and operates 10 hospitals and has an affiliated interest in one additional hospital. The organization employs over 1,300 health care providers through ProMedica Physicians and has more than 2,300 physicians and advanced practice providers with privileges. Committed to its mission of improving health and well-being, ProMedica has received national recognition for its clinical excellence and its initiatives to address social determinants of health.For more information about ProMedica, please visitpromedica.org/aboutus.

Benefits: We provide flexible benefits that include compensation and programs to help you take care of your family, your finances and your personal well-being. Its what makes us one of the best places to work, and helps our employees live and work to their fullest potential.

Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression, age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or any other legally protected category. In compliance with the Americans with Disabilities Act Amendment Act (ADAAA), if you have a disability and would like to request an accommodation in order to apply for a job with ProMedica, please contact [e-mail]

Equal Opportunity Employer/Drug-Free Workplace