Hmo Prior Authorization Coordinator - Whittier, United States - California Specialty Pharmacy

California Specialty Pharmacy

Verified Company

Whittier, United States

1 week ago

Posted by:

Mark Lane

beBee recruiter

Description

As a Prior Authorization/ Patient Care Coordinator you'll be responsible for; Heavy data entry; verifying that an Authorization is valid for service and submitting authorizations to multiple insurance plans.

Heavy attention to detail. Positive Team player mentality. Other task as assigned by supervisor.

REQUIRED EDUCATION/TRAINING/PROFESSIONAL EXPERIENCE - CUSTOMER SERVICE REPRESENTATIVE:

High School degree or equivalent G.E.D required
Knowledge of Microsoft Word, Excel; ability to work with multiple information systems
Knowledge of medical and pharmaceutical terminology (ICD10, Jcodes)
Medical Prior authorization Required
Pharmacy or medical office experience preferred
HMO, Medicare Insurance knowledge Required
45 wpm +

EXPECTED PROFESSIONAL COMPETENCIES:

General knowledge of pharmacy and healthcare laws and regulations
Engages in appropriate continuing professional development
Practices patient centered care
Practices professionally
Practices legally
Practices ethically
Decision making skills
Team working skills
Communication skills
Strong Problem Solving skills
Customer Service skills
Detail oriented

ROLES AND RESPONSIBILITIES

Initiate Prior authorizations along with work with MD contacts to make sure patients authorizations are being submitted in a timely manner.
Ensure the accuracy of prescription and patient data entered into various systems by verifying patient, drug, quantities, directions, day's supply, insurance, physician data.
Create physician profile in computer systems, demographics
Keep current and compliant with statutes, rules and regulations related to pharmacy
Participate in continuous improvement and quality assurance programs
Input insurance information, pharmacy and medical
Resolve aspects of specialty pharmacy and medical including Medicare, Medicaid, PBM, PPO and IPA and communicate with payers and advise patients or physician of results when needed.
Communicate with various pharmacy departments as needed to coordinate timely prescription adjudication to meet schedules.
If necessary, contact physician offices for refill authorizations
Report errors, omissions or incidents to pharmacists
Participate in quality program initiatives and improvement activities
Comply with all regulatory requirements, including HIPAA/HITECH
Other responsibilities as assigned by Management

PHYSICAL DEMANDS:

Frequent immobility and/or sitting required for extended periods of time. Some bending and stooping required. Requires manual dexterity to operate keyboard, calculator, photocopy machine, and other office equipment. Requires eyesight correctable to 20/20 to read reports and computer terminals. Requires hearing within normal range for telephone use. Occasional high stress work.

WORK ENVIRONMENT:

Normal office environment.

Experience:

Medical Assistants with Prior authorization Knowledge are Encouraged to apply
Medical Office Experience: (Preferred but not Required)

Salary:
$ $21.00 per hour DOE + monthly bonus after probation period

Benefits: