Prior Authorization Specialist, Medication Management

JOB DUTIES AND RESPONSIBILITIES:

• Monitors prior authorization work queues WQ(s) and promptly obtains and/or reviews patient insurance information and eligibility verification required to secure medication prior authorizations.
• Utilizes online, fax, and telephony pathways to obtain prior authorizations from insurance companies for prescribed medications and documents medication prior authorizations in the medical record as necessary.
• Seeks additional information and/or communicates updates to patients and providers as appropriate throughout the prior authorization process.
• Engages insurance company representatives and provides required clinical information to secure prior authorization, when necessary.
• Engages practice operations and incorporates clinical care team when prior authorization attempt is unsuccessful and/or a peer-to-peer and/or alternative medication is required.
• Escalates complex prior authorization issues to Supervisor, Medication Prior Authorization for assistance/guidance.
• Maintains working knowledge of St. Luke’s electronic medical record system, internal systems and tools, and other online insurance websites.
• Maintains solution-oriented/creative mindset to effectively anticipate and tend to patient needs by partnering with other organizational team members/departments.
• Actively participates in performance improvement and continuous quality improvement activities.
• Other related duties as assigned.

PHYSICAL AND SENSORY REQUIREMENTS:

Sitting for up to 8 hours per day, 3 hours at a time. Consistent use of hands and fingers for typing, telephones, data entry, etc. Occasional twisting and turning. Uses upper extremities to lift and carry up to 15 pounds. Stoops, bends, and reaches above shoulder level to retrieve files. Hearing as it relates to normal conversation. Seeing as it relates to general vision. Visual monotony when reading reports and reviewing computer screen.