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Prior Authorization Specialist * - Pharmacy Tech

Company: Central Florida Health Care, Inc.
Location: Winter Haven
Posted on: November 22, 2021

Job Description:

Title: Prior Authorization SpecialistReports to: Director of PharmacyFLSA Status: Non-Exempt
Personnel Supervised: None
POSITION SUMMARY:This position assists the medical and pharmacy departments in facilitating the prescription prior authorization process from beginning to end.MINIMAL QUALIFICATIONS:

  • Education: High School Diploma or GED
  • Florida Board of Pharmacy Registration
  • Active Pharmacy Technician Licensure (National) preferred
  • Active BLS
  • Minimum of six months of pharmacy technician experience
  • Basic Math skills
  • Computer literacy
  • Customer service experience
  • Strong verbal and written communication skills
  • Experience using an Electronic Health Record, Athena preferred
  • Knowledge of ICD 10 CodesRESPONSIBILTIES AND PERFORMANCE EXPECTATIONS include, but are not limited to, the following:
    • Be familiar with CFHC's program philosophies, goals, and objectives. Be cognizant of and comply with all CFHC's policies and procedures, as well as state and federal regulations.
      • Understand the requirements of CFHC's Exposure Control Plan. Assure compliance with this plan by support staff assigned to assist you.
        • Adheres to CFHC quality policies and participates actively in quality improvement process activities.
          • Follows safety and OSHA requirements.
            • Ability to initiate prior authorizations through CoverMyMeds
              • Ability to evaluate information from both oral and written sources, pharmaceutical references, and report information to patients and medical team members
                • Apply clinical knowledge when assessing and responding with alternatives to denied pharmacy prior authorizations
                  • Collaborate with other departments to assist in obtaining prior authorizations
                    • Conduct denial reviews to provide recommendations for providers and support appeals submission if requested
                      • Document all prior authorization information within the patients record
                        • Facilitate medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed
                          • Follow-up on all pending prior authorizations
                            • Identify insurance treatment requirements and review the patient medical record to assure the requirements are met for prior authorization approval
                              • Manage correspondence with insurance companies, physicians, pharmacies and patients as required
                                • Obtain approval/denial letters
                                  • Ability to sit for long periods of time, making continuous calls for the majority of all shifts
                                    • Ability to problem solve, multi-task, and prioritize work
                                      • Maintain patient confidentiality per HIPPA guidelines
                                        • May need to serve as a pharmacy technician in the pharmacy to assist with, but not limited to the following tasks:
                                          • Mix pharmaceutical preparations, fill bottles with prescribed tablets, and type labels for bottles.
                                          • Receives and stores incoming supplies.
                                          • Cleans equipment and glassware according to prescribed methods.
                                          • Files invoices and hard copy prescriptions.
                                          • Assist in the preparation of third-party billing.
                                          • Participate in drug review and drug product selection.
                                          • Maintain proper and safe drug storage and maintain accurate inventory and sales records.
                                            • Treat patients, staff, and visitors with courtesy, sensitivity, and respect
                                              • Report as needed to Pharmacy Director any pertinent information or situations that impact on patient care or CFHC liability.
                                                • Attend and participate in mandatory CFHC meetings (Center Specific quarterly meetings, Corporate meetings, and other meetings as designated by the CMO or CEO).
                                                  • Make recommendations to the Director of Pharmacy regarding the purchase of pharmacy supplies, instruments, and equipment, and repair and/or maintenance of these.
                                                    • Enhances professional growth and development by attending in-service meetings and continuing education programs.
                                                      • Maintain neat and professional appearance at all times.
                                                        • Carry out any other activities deemed appropriate by the Director of Pharmacy, CMO or CEO.PHYSICAL REQUIREMENTS:
                                                          • Requires 80% or more time spent standing/walking.
                                                            • Independently mobile.
                                                              • Working under tight deadlines.
                                                                • Ability to lift weight equivalent to that required when repositioning equipment and lifting supplies.
                                                                  • Ability to adapt and function in varying environments of workload, worksites and work shifts.
                                                                    • Environmentally exposed to a variety of contagious diseases and other patient related conditions.

Keywords: Central Florida Health Care, Inc., Lakeland , Prior Authorization Specialist * - Pharmacy Tech, Healthcare , Winter Haven, Florida

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