Medication Prior Authorization Specialist at American Addiction Centers

Elm Grove, Wisconsin, United States -

Full Time

Start Date

Immediate

Expiry Date

27 Mar, 26

Salary

32.2

Posted On

27 Dec, 25

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Insurance Verification, Eligibility Checks, Documentation, Customer Service, Communication, Problem Solving, Technical Proficiency, Medical Terminology, Critical Thinking, Mathematical Aptitude, Collaboration, Confidentiality, Epic EMR, Patient Assistance, Referral Processes, Authorization Processes

Industry

Hospitals and Health Care

Description

Department: 38528 Enterprise Pharmacy - Patient Assistance: Non Specialty Status: Full time Benefits Eligible: Yes Hours Per Week: 40 Schedule Details/Additional Information: Mon - Fri from 8:30 to 5pm Position is 100% remote Pharmacy tech experience is preferred Pay Range $21.45 - $32.20 Major Responsibilities: Ability to complete insurance verification and eligibility checks. Ability to collect and accurately document initial pre-certification/authorization information if available. Initiates the process for obtaining a required referral/authorization if not obtained. Ability to work assigned Epic work queue, following the department’s workflow process on appropriately transferring, deferring, or removing orders from the work queue. Ability to proactively communicate issues involving customer service and process improvement opportunities to management. Maintains excellent public relations with patients, patient's families and clinical staff as well as demonstrates a willingness and ability to work collaboratively with others for concise and timely flow of information. Maintains knowledge of and reference materials for Medicare, Medicaid and third-party payer requirements guidelines and policies, insurance plans requiring pre-authorization/referral and a list of current accepted insurance plans. Ability to update the patient, physician's office, and any necessary parties, through multiple methods as appropriate (including telephone, in-basket messaging, and electronic medical record), regarding responses and outcomes of the prior authorizations. Ability to act as a liaison between physician's office, patient, and pharmacy benefit manager to initiate and resolve appeals, as needed. Licensure, Registration, and/or Certification Required: None Required. Education Required: High School Graduate. Experience Required: Typically requires 1 year of experience in health care, insurance industry, pharmacy, or medical background. Knowledge, Skills & Abilities Required: Demonstrated ability to identify and understand issues and problems. Examines data and draws logical conclusions based on information available. Knowledge and ability to articulate explanations of Medicare/HIPAA/EMTALA rules and regulations and comply with updates on insurance pre-certification requirements. Mathematical aptitude, effective communication skills and critical thinking skills. Understanding of basic human anatomy, medical terminology and procedures for application in the patient referral/pre certification/authorization processes. Ability to speak effectively to customers or employees of the organization, maintaining a pleasant, professional demeanor. Ability to handle sensitive and confidential information according to internal policies. Ability to problem solve in a high profile and high stress area, working independently to set and meet deadlines and prioritize work. Demonstrated technical proficiency including experience with insurance verification/eligibility tools, Epic electronic medical record, patient liability estimation tools, Microsoft Office, Internet Explorer and phone technology. Physical Requirements and Working Conditions: Must be able to sit majority of the workday Occasionally lifts up to 10 lbs. Operates all equipment necessary to perform the job. This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties. Our Commitment to You: Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including: Compensation Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training Premium pay such as shift, on call, and more based on a teammate's job Incentive pay for select positions Opportunity for annual increases based on performance Benefits and more Paid Time Off programs Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability Flexible Spending Accounts for eligible health care and dependent care expenses Family benefits such as adoption assistance and paid parental leave Defined contribution retirement plans with employer match and other financial wellness programs Educational Assistance Program About Advocate Health Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits. This is Transformation One shared purpose brought us together. Now, as one of the 10 largest not-for-profit, integrated health systems in the United States, our combined strength and stability drives us forward. Starting with You Caring for nearly 3 million people has inspired a transformation. One in which the patient’s experience guides our vision and empowers us to offer new possibilities in our communities. Reshaping Access What is access? It’s offering more sites of care than any other health system in the Midwest. But there’s a new frontier. Access is exploring the latest technologies to deliver care to patients exactly where they are and exactly when they need it Inspiring Professionals With our dynamically inclusive workforce and strong connections to the places where we live and work, we’ll touch more lives and contribute to stronger and more vibrant communities. Transforming Care We’re redefining the standard for care with world-class doctors and caregivers, innovative solutions, outstanding outcomes, and leading-edge research and clinical trials. Combined, Advocate and Aurora are recognized for clinical excellence in: Cardiovascular Care Neurosciences Gynecology Oncology Pediatrics Primary Care Neurology Geriatrics Trauma Care

Responsibilities

The specialist is responsible for completing insurance verification and eligibility checks, as well as documenting pre-certification information. They also communicate with patients and healthcare providers regarding prior authorizations and appeals.