LakelandRecruiter Since 2001
the smart solution for Lakeland jobs

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

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Log In or Create An Account

Get the latest Florida jobs by following @recnetFL on Twitter!

Lakeland RSS job feeds