Prior Authorization Specialist

Job Summary:

The Pharmaceutical assistant is responsible for providing comprehensive oversight for all patients in need of medication. They are an integral part of the corporate team and works to ensure our patients have access to the appropriate medication by working with CoreLife clinical and administrative staff as well as insurance and pharmaceutical companies.  

Job Responsibilities:

• Responsible for meeting all KPI’s for position
• Responsible for downloading PA requests and entering into CMM 
• Track all other appropriate patient and pharmaceutical information with the goal of accurate information
• Will be responsible for resulting out the PA, documenting, and following up on all open PA’s not escalated to management
• Must be able to communicate effectively with providers and office staff through email and phone calls regarding any issue with the PA process and/or individual patients, such as incomplete information, answering status questions, etc
• Must be able and willing to call pharmacy, patient, and insurances when needed in order to successfully complete PA’s
• Must determine which PA’s require escalation or further assistance from management
• Must complete all necessary training for EHR systems such as Nextgen and EPIC
• Must possess a working knowledge of pharmacy processes 
• Must work diligently to assistant clinical and administrative teammates within the clinic
• Must be pleasant and willing to learn, take direction, ask questions, express needs and communicate effectively in a positive way with all staff

Qualifications

• Minimum 2 years experience
• Previous work experience with insurances necessary
• Knowledge of medical codes
• Interest and/or experience in community health settings
• Experience working in a diverse environment
• Excellent written and verbal communication, and team practice Pharmaceutical assistant skills required

Adherence to CoreLife’s Values:

• Meeting the needs of our patients & ensuring the highest level of patient experience, care, and outcomes           
• Treating our patients, teammates, and partners with honesty, respect, integrity, and teamwork
• Challenging patients, teammates, and partners to achieve exceptional results and potential

Work Environment:

This job operates in a professional medical office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.

Physical Demands;

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand; walk; use hands to handle or feel; and reach with hands and arms.

This position requires the ability to occasionally lift office products and supplies, up to 20 pounds.

Other Duties:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Note: reasonable accommodations may be made available for individuals with disabilities to perform the essential functions of this position.