Overview

Job Summary: Responsible for all aspects of drafting and completing prior authorizations, entering of medication orders and customer service for patients, and working as liaison with pharmacy team and provider offices.

Responsibilities

• Educate prospective pharmacy patients on how the specialty pharmacy serves patients and improves their overall care
• Resolve insurance related issues, complete benefit investigations, including prior authorizations (PAs) as an agent of the provider
• Review the patients need for financial assistance and secure financial assistance when needed and available
• Document patient information within the hospital EMR, QS1, Therigy and all proprietary tools as required
• Secure prescription renewals
• Communicate directly with patients to assist them in the awareness of their medications
• Identify medications requiring special storage and/or handling such as hazardous medications and/or refrigerated medication
• Answer, resolve and triage inbound inquiries
• Apply observations and recommendations to operational issues, increased productivity, quality, and customer-service standards
• Actively participate in process improvement initiatives.
• Responsible for monitoring adjudication queue(s) and facilitate prior authorization process for customers
• Responsible for ensuring a high level of successful prior authorizations
• Responsible for Appeals Requests and External Appeals Requests when necessary.
• Act as liaison with Clinical and Pharmacy Team in communicating with provider offices on questions regarding appropriateness of therapy, labs or other questions/concerns and provide support for prior authorization, financial assistance, and prescription fill and renewal
• Responsible for accurate selecting billing and shipping methods for incoming patient orders
• Document patient reported information into TherigySTM
• Responsible for accurate data entry of incoming prescriptions, if required
• Provides resolution to customer service issues to ensure member satisfaction
• Customer service coverage for incoming calls, and making outbound calls to set up customer deliveries
• Responsible for completing all mandatory and regulatory training programs
• Perform other duties as assigned

Qualifications

Educational Requirements:

• Minimum: High School Diploma or GED
• Preferred: Pharmacy technician or related certification

Experience: 

• Experience with Prescription Prior Authorizations required
• 6-12 months experience as a pharmacy technician preferred

Job Skill Requirements:

• Broad knowledge of medications, physician orders, and pharmacy systems
• Familiar with Enterprise billing options and practices surrounding claim submission
• Strong communication skills
• Outstanding customer service skills
• Excellent organization skills
• Ability to multitask and prioritize
• Excellent computer and keyboarding skills

 Compensation:

$18.02-27.03 per hour.

The final offer will be determined after careful consideration of multiple factors such as relevant skills, years of experience and education. 

KPH Healthcare Services, Inc. is a multistate organization and abides by all local, state and federal regulations as it pertains to minimum wage requirements.