Prior Authorization Specialist - Pharmacy

Description

Professional - Nonclinical
Req #: 30124

($3,000.00 Sign on Bonus paid in 3 installments, prorated for PartTime)

Current MaineHealth employees not eligible for the sign on bonus. Must be separated from MaineHealth system for 6months to be eligible.

Summary

Responsible for assisting patients and providers with the pre-authorization of medications, as required by patient's insurance plan. Verifies insurance eligibility and benefits. Documents information obtained from insurances and communicates with insurances, patients and clinical staff following appropriate protocols and workflows in the EMR. Responsible for ensuring that all medication pre-authorization requests are processed in an accurate and timely manner for continuity of patient care. Collaborates and communicates regularly with clinical departments to ensure efficiency in authorization processes. ThePrior Authorization Specialisthas an expertise in obtaining and maintaining pre-authorizations from insurance companies, allowing patients to quickly access the important treatment they need. This is a hybrid role that allows working remotely with the ability to come in-office for training and as needed.

Required Minimum Knowledge, Skills, and Abilities (KSAs)

1. Education: High school diploma or GED preferred.
2. License/Certifications: N/A
3. Experience: Experience as a medical assistant, pharmacy technician, or prior authorization work in healthcare or related environment required.
4. Additional Skills/Requirements Required: N/A
5. Additional Skills/Requirements Preferred: Medical Terminology. Knowledge of Medical Insurance and concept of referrals/pre-authorizations.

If you have questions about this role, please contact Todd R. Nevins at todd.nevins@mainehealth.org