Prior Authorization Specialist CPhT - Dallas, United States - Cloud Rx Pharmacy

Description

Position SummaryAt Cloud Rx, the Prior Authorization Specialist plays a vital role in the healthcare system by facilitating the prior authorization process for prescription medications.

This individual is responsible for ensuring that patients receive timely approvals for medications that require pre-approval from insurance providers or other relevant entities.

The role also involves patient interaction, acting as a liaison and educator to provide guidance and support regarding the prior authorization process and medication adherence.

Additionally, the Prior Authorization Specialist is accountable for managing clinic chats to address any queries or concerns related to prior authorizations.

At Cloud Rx, we understand that our business thrives when our employees thrive, and it begins with hiring the right Pharmacy Technician.

Essential Duties and ResponsibilitiesThe essential functions include, but are not limited to the following:

Prior Authorization Process Management:
Review prescription orders to identify medications requiring prior authorization. Initiate prior authorization by collecting and verifying patient information and medical history. Collaborate with healthcare providers and insurance companies to submit accurate requests. Ensure completed forms and documentation are attached.


Patient Liaison/Educator:
Assist patients with the prior authorization process. Educate patients on its importance and potential outcomes. Address patient concerns and provide medication options. Coordinate with healthcare providers as needed.


Clinic Chats Management:
Conduct real-time chats to resolve prior authorization queries. Collaborate with the healthcare team for seamless communication. Maintain records and follow up on action items.


Data Entry:
Perform accurate data entry to update prescription records and patient information, ensuring compliance with regulatory requirements

Inbound Calls Management:

Manage inbound calls from clients, healthcare professionals, and stakeholders, offering courteous and knowledgeable assistance for inquiries and medication-related concerns.

Utilize active listening to address needs or direct calls to the appropriate department.


Documentation and Compliance:
Keep detailed records of prior authorization activities. Comply with pharmacy industry regulations and data protection protocols.


Quality Assurance and Process Improvement:
Participate in quality assurance initiatives. Provide feedback to optimize the prior authorization workflow. Stay updated on insurance policies and industry developments.
KPIs Responsibilities; Patient turnaround time, other metrics.
Other assigned duties.
Minimum Qualifications (Knowledge, Skills, and Abilities)Certification as a Pharmacy Technician (CPhT) by an accredited certifying body.
In-depth knowledge of pharmaceuticals, medical terminology, and the prior authorization process.
Strong communication and interpersonal skills to effectively liaise with patients, healthcare providers, and insurance companies.
Excellent organizational abilities to manage prior authorization requests and clinic chats efficiently.
Proficiency in using relevant software and systems for prior authorization submissions and documentation.
Attention to detail and accuracy in completing prior authorization forms and related paperwork.
Ability to work independently and collaboratively in a fast-paced healthcare environment.
Commitment to patient care and ensuring medication access through the prior authorization process.

Physical Demands and Work EnvironmentThe physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position.

Reasonable accommodation may be made to enable individuals with disabilities to perform the functions.
Prolonged periods sitting at a desk and working on a computer. Prolonged periods of standing and bending.

The employee is frequently required to walk; use hands to finger, handle, or feel; and reach forward with hands and arms.

The employee is also occasionally required to sit and stoop, kneel, or crouch.
The employee must occasionally lift and/or move up to thirty pounds.


Note:

This job description in no way states or implies that these are the only duties to be performed by the employee(s) of this position.

Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by any person authorized to give instructions or assignments.

All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities.

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