- Prioritize and process incoming prior authorization requests with urgency, utilizing CoverMyMeds, payer websites, and phone calls as needed.
- Review and verify patient information, medical records, and insurance coverage to ensure accurate and complete documentation for authorization submissions.
- Collaborate with healthcare providers, insurance companies, and internal departments to obtain necessary information and documentation for prior authorization requests.
- Initiate appeals for denied authorizations, and follow-up regularly on pending cases.
- Obtain copay assistance for patients.
- Maintain accurate and up-to-date records of all prior authorization requests, approvals, and denials.
- Ensure compliance with regulatory requirements and company policies regarding documentation and record-keeping.
- Communicate with clinic staff and pharmacies keeping everyone informed on authorization status and requirements.
- Contact patients to discuss authorization status and to set up delivery of medication(s)
- Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations.
- Consistently follow policies and procedures required by state and federal laws, and as required by UVA Health System.
- Triage and escalate any questions or issues outside the pharmacy technician scope of practice to the staff pharmacist or supervisor as needed
- Participate in the training of new employees
- In addition to the above job responsibilities, other duties may be assigned.
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Prior Authorization Tech - Charlottesville, United States - Virginia Jobs
Description
As a Prior Authorization Technician at UVA Specialty Pharmacy, you will play a crucial role in positively impacting the lives of patients in the fastest growing part of the pharmacy industry. In this role, your primay resposiblity will involve obtaining medication authorizations from insurance plans, ensuring that patients have timely access to critical medications. The job also requires assessing patient eligibility and investigation for pharmaceutical medication assistance programs. The use of independent judgment in a patient care setting is required for this job role. Additionally, you will beexpected to stay informed about changes in carrier contracts, as well as departmental policies and procedures, to maintain the highest level of service and compliance. This position is vital for enhancing patient access to necessary treatments and supporting overall healthcare outcomes.
MINIMUM REQUIREMENTS
Education: High School Graduate or Equivalent
Experience: 6 months minimum relevant experience required
License/Certification: Commonwealth of Virginia Pharmacy Technician Registration required. CPhT credential through National Healthcareer Association (NHA) or Pharmacy Technician Certification Board (PTCB) required. For team members hired prior to February 1, 2020, certification as CPhT through NHA or PTCB is required by January 31, 2022.
PHYSICAL DEMANDS
Job requires standing for prolonged periods. Proficient communicative, auditory and visual skills; Attention to detail and ability to write legibly; Ability to lift/push/pull less than 20lbs.
The University of Virginia, i ncluding the UVA Health System which represents the UVA Medical Center, Schools of Medicine and Nursing, UVA Physician's Group and the Claude Moore Health Sciences Library, are fundamentally committed to the diversity of our faculty and staff. We believe diversity is excellence expressing itself through every person's perspectives and lived experiences. We are equal opportunity and affirmative action employers. All qualified applicants will receive consideration for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, race, religion, sex (including pregnancy), sexual orientation, veteran status, and family medical or genetic information.
