[Hiring] Prior Authorization Pharmacy Specialist I @Florida Cancer Specialists

Role Description

The Prior Authorization Specialist is responsible for performing prior authorizations and appeals for oral oncology and supportive medications as an extension of the FCS medical practice. The Prior Authorization Specialist will interact with patients, caregivers, and healthcare providers regarding inquiries for prescription status. The specialist will assist the pharmacy staff and other health care professionals in supporting prescription processing to ensure prompt service and quality patient care.

• Demonstrates effective communication skills and premier customer service to successfully interact with all levels of internal and external parties to convey information correctly.
• Performs clinical reviews of patients’ charts using appropriate criteria to complete prior authorizations.
• Processes appeals for prior authorization denials according to specific insurance plan requirements, provides documentation and composing a letter of medical necessity as appropriate.
• Obtains prior authorization approvals utilizing online authorization sites (ex: Eviti, New Century Health, Cover My Meds) and prior authorizations via fax and phone.
• May require interpretation or clinical data deviation from standard procedures.
• Escalates complex clinical concerns to the appropriate clinician with a goal of first call resolution.
• Complies with all accreditation standards, federal and state laws and regulations pertaining to patient privacy, patient’s rights, personnel law, safety, labor, and employment law.
• Adheres to Company and departmental policies and procedures, including IT, HR, and compliance policies and procedures and Disaster Recovery Plan.
• Participates in the pharmacy’s Continuous Quality Improvement (CQI) program by identifying and reporting quality related events.
• Additional tasks as needed to support the team and FCS.

Qualifications

• A high school diploma or GED Required
• Active Registered Florida Pharmacy Technician license and state of residence is required.
• Active National Pharmacy Technician Certification is required.
• Prior Authorization Certified Specialist (PACS) certification preferred.

Requirements

• Pharmacy benefit prior authorization experience preferred.
• Minimum three (3) years’ experience working in a health care or customer service-related field, preferably pharmacy or call center required.
• Hematology/oncology experience preferred.

Benefits

• Competitive salaries
• Comprehensive benefits packages including tuition reimbursement
• 401-K match
• Pet and legal insurance

Expectations for all Employees

Every FCS employee is expected to regularly conduct themselves in a professional and respectful manner, to comply with all labor laws, workplace policy and workplace practices. Employees are expected to bring issues of any forms of workplace harassment, discrimination, or other potential improprieties to the attention of their management or the human resources department.