[Hiring] Pharmacy Prior Authorization Agent-Specialty @American Addiction Centers

Role Description

• Complete insurance verification and eligibility checks.
• Collect and accurately document initial pre-certification/authorization information if available.
• Initiate the process of obtaining a required referral/authorization if not obtained.
• Work assigned Epic work queue, following the department’s workflow process on appropriately transferring, deferring, or removing orders from the work queue.
• Proactively communicate issues involving customer service and process improvement opportunities to management.
• Maintain excellent public relations with patients, patients’ families, and clinical staff.
• Demonstrate a willingness and ability to work collaboratively with others for concise and timely flow of information.
• Maintain knowledge of and reference materials for Medicare, Medicaid, and third-party payer requirements, guidelines, and policies.
• Update the patient, physician's office, and any necessary parties regarding responses and outcomes of the prior authorizations.
• Act as a liaison between physician's office, patient, and pharmacy benefit manager to initiate and resolve appeals, as needed.
• Identify and assist patients with access to internal and external financial assistance programs.
• Communicate to the patient and/or physician's office when authorization is not obtained, or services are not covered, and explain the potential financial responsibility.
• Coordinate with patient, clinical team, and assistance programs to secure reimbursement or alternative covered options.
• Manage incoming and outgoing calls, which may include other Advocate team members, departments, patients, insurance plans, and/or copay foundation/assistance programs.

Qualifications

• High School Graduate

Requirements

• Typically requires 1 year of experience in health care, insurance industry, pharmacy, or medical background.
• Demonstrate ability to identify and understand issues and problems.
• Ability to problem solve in a high profile and high stress area.
• Mathematical aptitude, effective communication, and critical thinking skills.
• Ability to prioritize and organize workload.
• Excellent verbal and written communication skills.
• Demonstrated technical proficiency including experience with insurance authorization/eligibility tools, EPIC, Microsoft Office, Internet browser, and telephony systems.

Benefits

• Base compensation within the listed pay range based on 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.
• 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.