Pharmacy Prior Authorization Specialist

Seattle Children's; Seattle (WA); On-site; USD 45,000 - 68,000; Full time

Benefits offered by this job

Medical, dental, and vision plans

403(b) retirement plan

Life insurance

Paid time off

Job summary

Seattle Children's is seeking a PA Specialist responsible for all aspects of the prior authorization process, ensuring compliance and accurate documentation. You will collect documentation, request information, and submit PA and retro authorization requests to payors while coordinating with clients, patients, and care teams.

The role requires WA-licensed pharmacy technician with 3 years retail or outpatient experience; familiarity with Epic and CoverMyMeds; strong customer service and attention

Qualifications

• ,
• High school diploma or GED.
• Graduation from an accredited pharmacy technician program, or equivalent training.
• Minimum of three years of retail or outpatient pharmacy experience.

Responsibilities

• Collect required documentation for PA.
• Identify and submit PA and retro authorization requests to payors.
• Interact with clients, patients, and care teams to obtain information.
• Document account activity and update patient and claim information.
• Utilize Epic, CoverMyMeds, and other billing platforms to ensure efficient processing.

Skills

Customer service

Communication

Attention to detail

Education

High school diploma or GED

Graduate of accredited pharmacy technician program or equivalent

Minimum of three years retail/outpatient pharmacy experience

Tools

Epic

CoverMyMeds

Job description

The Prior Authorization (PA) Specialist is responsible for all aspects of the prior authorization process while continuously monitoring and ensuring compliance through established procedures and documentation. Responsibilities include collecting all the necessary documentation, contacting the client for additional information to complete the PA process. Complete, timely, and accurate identification and submission of prior and retro authorization requests to payors. Interacts with clients, insurance companies, patients, as necessary, to request for prior authorizations. Responsible for documenting account activity, updating patient and claim information and demonstrates proficiencies with Epic, CoverMyMeds, and other billing platforms to ensure all functionalities are utilized for the most efficient processing of claims and identifies PA trends and/or issues resulting in delayed claims processing. Provides the highest level of customer service to internal care teams and patients and families.

Required Education/Experience:

• High school graduate or G.E.D.

• Graduation from accredited pharmacy technician training program, or equivalent training.

• Minimum of three (3) years of retail or outpatient pharmacy practice experience.

Required Credentials:

• Licensed by the Washington State Pharmacy Department of Health as a pharmacy technician.

Preferred:

• One (1) year Seattle Children's Outpatient Pharmacy experience.

• Specialty Pharmacy and/or Centralized Prior Authorization Services knowledge.

Compensation Range

$32.87 - $49.31 per hour

Salary Information

This compensation range was calculated based on full-time employment (2080 hours worked per calendar year). Offers are determined by multiple factors including equity, skills, experience, and expertise, and may vary within the range provided.

Disclaimer for Out of State Applicants

This compensation range is specific to Seattle, positions located outside of Seattle may be compensated differently depending on various factors.

Benefits Information

Seattle Children’s offers a generous benefit package, including medical, dental, and vision plans, 403(b), life insurance, paid time off, tuition reimbursement, and more. Additional details on our benefits can be found on our website www.seattlechildrens.org/careers/benefits .

About Us

Hope. Care. Cure. These three simple words capture what we do at Seattle Children’s – to help every child live the healthiest and most fulfilling life possible. Are you ready to engage with a mission-driven organization that is life-changing to many, and touches the hearts of all? #HOPECARECURE

Our founding promise to the community is as valid today as it was over a century ago: we will care for all children in our region, regardless of the families’ ability to pay. Together, we deliver superior patient care, advance new discoveries and treatments through pediatric research, and serve as the pediatric and adolescent, academic medical center for Washington, Alaska, Montana and Idaho – the largest region of any children’s hospital in the country.

U.S. News & World Report consistently ranks Seattle Children’s among the nation’s best children’s hospitals. For more than a decade, Seattle Children’s has been nationally recognized in key specialty areas. We are honored to be one of the nation’s very best places to care for children and the top-ranked pediatric hospital in Washington and the Pacific Northwest.

As a Magnet designated institution, we recognize the importance of hiring and developing great talent to provide best-in-class care to the patients and families we serve. Our organizational DNA takes form in our core values: Compassion, Excellence, Integrity, Collaboration, Equity and Innovation. Whether it’s delivering frontline care to our patients in a kind and caring manner, practicing the highest standards of quality and safety, or being relentlessly curious as we work towards eradicating childhood diseases, these values are the fabric of our culture and community. The future starts here.

Our Commitment

Seattle Children’s welcomes people of all experiences, backgrounds, and thoughts as this is what drives our spirit of inquiry and allows us to better connect with our patients and families. Our organization recruits, employs, trains, compensates, and promotes based on merit without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.

The people who work at Seattle Children’s are members of a community that seeks to respect and celebrate all the qualities that make each of us unique. Each of us is empowered to be ourselves.

Seattle Children’s is proud to be an Equal Opportunity Workplace and Affinitive Action Employer.