Specialist, Pharmacy Authorization

OneOncology; United States; On-site; USD 42,000 - 65,000; Full time

Job summary

New York Cancer & Blood Specialists is seeking a Pharmacy Authorization Specialist to support the oncology care team. You will run daily OncoEMR reports, process drug order approvals, and manage prior authorizations to ensure timely access to medications for patients.

Attention to detail, strong communication skills, and the ability to multitask in a fast-paced clinical environment are essential. This on-site role offers overtime opportunities as needed within a supportive healthcare setting.

Qualifications

• High school diploma or GED.
• Experience in pharmacy/authorization field.
• Experience in healthcare/billing environment.
• Experience with ICD-10 and CPT coding.
• Experience with billing practice management systems, EMR, Word and Excel.

Responsibilities

• Run daily OncoEMR reports for drug order values and obtain prior authorizations.
• Process STAT orders immediately.
• Handle daily requests to obtain prior authorization for medications.
• Document notes in patient treatment plans and approval status.
• Prepare appeals for denials of prior authorization requests.
• Refer denied or patient financial responsibility cases to pharmacy financial counselor.
• Verify all approvals meet NYCBS policy and pre-certification requirements.
• Coordinate with pharmacy and nursing to manage prior authorizations.
• Maintain confidentiality of patient and employee information.
• Overtime may be required with notice.

Skills

Verbal communication

Multitasking

Problem solving

Interpersonal skills

Time management

Education

High school diploma

Tools

OncoEMR

Microsoft Word

Microsoft Excel

Billing software

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

• 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.

Requirements

• 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.

New York Cancer and Blood Specialists, the best in Long Island cancer treatment: a comprehensive community oncology center delivering more personalized services and faster access to technologies and treatments. Be part of an innovative team of world class licensed professionals.