MINIMUM EDUCATION AND EXPERIENCE:

• High School Diploma or General Education Diploma (G.E.D).
• Three (3) years of experience working with insurance plans, Pharmacy benefits (PBM), and eligibility.
• Two (2) years experience processing Medication Prior Authorizations, insurance verification and formularies.
• Familiarity with EHR’s EPIC
  If applicable, equivalent combination of education and experience may be considered, and must be directly related to the functions and responsibilities of the job.

PREFERRED EDUCATION, EXPERIENCE, SKILLS, ABILITIES:

• Associate’s Degree in a Business or Finance related field from an accredited College or University.
• A current License as a Pharmacy Technician in accordance with the Arizona State Board of Pharmacy requirements.
• Two (2) years administrative experience, preferably in a healthcare environment.
• Bilingual (English/Spanish) with the ability to speak, read and write in both languages.
  Reasonable accommodations may be made to enable individuals with disabilities; known limitations related to pregnancy, childbirth, or related medical conditions; and for sincerely held religious beliefs, observances, and practices to perform the essential functions of the job.
  El Rio Health does not discriminate based on race, color, religion, sex (including pregnancy, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, or other non-merit-based factors. It is our intention that all qualified applicants be given equal opportunity and that selection decisions are based on job-related factors.
  El Rio Health requires all employees to have a Level One Fingerprint Clearance card. A.R.S. 36.425.03. If the prospective employee does not possess this prior to hire, fingerprint application must be completed within 7 days post hire. Level One (1) Non-IVP Fingerprint Clearance card must be received within 30 days after applying for the fingerprint card.
  All employees are strongly recommended to obtain and maintain vaccination status (i.e., as recommended by CDC and/or other public health agencies) to include an Influenza vaccination.
  Subject to exemptions and accommodations when required by law. (Policy: Adm-016 & Adm-045).
  All employees are required to undergo drug testing prior to employment and will be subject to post-accident, reasonable suspicion, return to duty and follow up drug and alcohol testing in compliance with Federal and State regulations for alcohol and controlled substance testing. Employees in positions holding responsibility for the safety and welfare of others will also be classified as safety sensitive.
  El Rio Health is a non-profit 501(c)(3) Federally Qualified Health Center (FQHC) and abides by all applicable federal Drug-Free Workplace standards. El Rio Health is an equal opportunity employer

The Medication Prior Authorization Specialist is responsible for facilitating and processing medication prior authorizations to ensure timely patient access to prescribed therapies. This role operates within the Quality Department and is responsible for ensuring that all processes related to medication prior authorizations adhere to regulatory standards, quality control protocols, and best practices. The Medication Prior Authorization Specialist’s main function is to complete prescription prior authorizations. The Medication Prior Authorization Specialist ensures patients receive medications that require pre-authorization from insurance carriers. Communicates with plans and pharmacy by analyzing insurance prior authorization requirements. It is the responsibility of the Medication Prior Authorization Specialist to receive, process and document all requirements, submit the required documentation, and update the Prior Authorization submission documents when necessary. They will collaborate with cross-functional teams to monitor, assess, and improve the quality of processes for prescription prior authorizations and medication services. This role requires a deep understanding of quality assurance principles, and strong analytical skills. In addition, the Specialist may be asked to perform other tasks in support of the Quality and Innovation team. The Medication Prior Authorization Specialist serves in a specialized administrative support role.
In this position, the defined duties and responsibilities for a Medication Prior Authorization Specialist will adhere to the regulations and the Policies and Procedures of El Rio Health. The Quality team works with periodic supervision and review, and any work problems involving departures from standard policies, interpretations, or procedures are reviewed with the supervisor for direction and resolution.