Specialist, Pharmacy Authorization

OneOncology; Shirley (NY); On-site; USD 50,000 - 75,000; Full time

Job summary

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.

Responsibilities

• 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.

Skills

Verbal communication

Interpersonal skills

OncoEMR

Microsoft Word

Microsoft Excel

Education

High School diploma or GED

Tools

OncoEMR

EMR systems

Job description

Why Join Our Team?

At New York Cancer & Blood Specialists (NYCBS), we are dedicated to making a difference in the lives of our patients, their families, and our communities. Our passionate team of expert oncologists, hematologists, and healthcare professionals work together to provide world-class cancer care close to home. By offering cutting-edge treatments, innovative research, and a patient-centered approach, we are redefining what’s possible in the fight against cancer and blood disorders.

If you want to be part of a growing organization committed to healing, hope, and advanced care , join us and help make a meaningful impact!

Job Description:

In This Role, You Will:

• Run and work daily Business Office Report in OncoEMR for drug order values: POD Verify and
• NYCBS Pharm Fill for current date of service and one week out to be worked to obtain prior
• authorizations. All STAT orders are to be worked immediately upon request by onsite team.
• Work daily requests from onsite pharmacy dispensaries to obtain prior authorization on
• requested medication.
• Document notes in the Sig Box of OncoEMR in the patient’s treatment plan including approval
• status or in text note where applicable. Must document all steps taken in research/process of the
• case
• Prepare appeals for denials on prior authorization requests where applicable.
• Refer prescription fill requests that are denied or that have a patient financial responsibility to the
• pharmacy financial counselor for review.
• Ensure that all aspects of approval have been checked regarding prior authorization, pre-
• determination, and pre-certification before approving the order as meeting NYCBS policy.
• Verify patient’s own drug with pharmacy related queries where applicable.
• Notify Nursing Management if orders need to be changed to BB (patient’s own drug) or to
• Buy/Bill (billing through medical insurance)
• Work any prior authorization requests from local pharmacies on patient’s oral medications or on
• specialty pharmacy drugs.
• Maintain and ensure the confidentiality of all patient and employee information at all times.
• A pharmacy authorization specialist will be expected to work when given sufficient notice of
• required overtime.

We Require:

• High school or GED required.
• Experience in pharmacy / authorization field.
• Experience working in the healthcare field, preferably in a clinical setting or business office.
• Experience in insurance requirements and medical terminology ICD-10 and CPT coding.
• Experience in billing practice management systems, electronic medical record systems, Microsoft
• Word, and Microsoft Excel.
• Excellent verbal and communication skills between co-workers, physicians, management staff,
• patients, insurances, outside programs.
• Ability to multitask, problem solve, utilize basic math skills and follow complex instructions.
• Must have ability to converse in a calm and friendly manner.
• Able to relate and comfort patients during a difficult time.