Pharmacy Authorization & Financial Coordinator

Essential Functions

• Verifies prescription benefits and eligibility.
• SUBMIT PRIOR AUTHORIZATIONS FOR MEDICATIONS AND FOLLOW UP IN A TIMELY MANNER.
• REPROCESS INSURANCE CLAIMS FOR MEDICATIONS AS NEEDED.
• COMMUNICATES WITH PATIENT ON AUTHORIZATION STATUS, OUTCOME, AND ANY INDIVIDUAL NEEDS TO OBTAIN MEDICATION.
• RESEARCHES AND FOLLOWS PBM GUIDELINES AND POLICIES.
• RESOLVES ISSUES THAT INHIBIT PATIENT FROM OBTAINING PRESCRIPTION MEDICATIONS ORDERED BY THEIR CLINIC PROVIDER.
• ANSWERS PHONE CALLS AND RETURNS VOICEMAILS IN A TIMELY MANNER.
• RESOLVES ASSIGNED TASKS IN THE ELECTRONIC HEALTH RECORD.
• ADHERES TO COMPLIANCE OF OAC POLICIES AND STANDARD OPERATING PROCEDURES.
• SETS THE STANDARD FOR THE TEAM BY PROVIDING EXCELLENT PATIENT CARE.
• OFFERS OTHER TEAM MEMBERS ASSISTANCE AS NEEDED.
• MANTAINS OPEN AND POSITIVE LINES OF COMMUNICATION, AND FUNCTIONALITY.
• UNDERSTANDS AND ADHERES TO HIPAA LAWS AND REGULATIONS IN COMPLIANCE AND PATIENT CONFIDENTIALITY.

Knowledge Performance Requirements

• KNOWLEDGE OF PHARMACY CLAIM REJECTIONS AND PRIOR AUTHORIZATIONS.
• KNOWLEDGE OF MEDICARE, MEDICAID, AND COMMERCIAL PBMS.
• KNOWLEDGE OF INSURANCE PLAN FORMULARIES AND STEP THERAPY GUIDELINES.
• KNOWLEDGE OF BRAND/GENERIC CONVERSIONS AND PROFICIENT IN PHARMACY MATH CALCULATING DOSE OR DAY SUPPLY.
• KNOWLEDGE OF PRESCRIPTION MEDICATIONS AND THEIR FDA APPROVED USE AND DOSAGE.
• KNOWLEDGE OF OKLAHOMA STATE PHARMACY BOARD RULES AND REGULATIONS.
• PROFICIENT IN COVERMYMEDS, EHR SYSTEMS, AND MICROSOFT OFFICE.

Skills

• EXCELLENT CUSTOMER SERVICE SKILLS.
• Clinical, Analytical, and Problem Solving Skills.
• ABILITY TO RECOGNIZE, EVALUATE, AND CORRECT ERRORS.
• ABILITY TO ESTABLISH PRIORITIES AND COORDINATE WORK ACTIVITIES.
• ATTENTION TO DETAIL.
• Able to type 50 words per minute.
• Office (Outlook, Word, Excel, PowerPoint).

Qualifications

• 1-2 YEARS OF EXPERIENCE WITH PHARMACY BILLING, INSURANCE, PRIOR AUTHORIZATIONS, MEDICAL BILLING, OR A RELATED FIELD PREFERRED.
• 2+ YEARS’ EXPERIENCE AS PHARMACY TECHNICIAN.
• HIGH SCHOOL DIPLOMA OR EQUIVALENT.
• OKLAHOMA PHARMACY TECH LICENSE - REQUIRED.
• SPECIALTY PHARMACY EXPERIENCE – PREFERRED.
• LIBERTY EXPERIENCE – A PLUS.
• EHR SYSTEM EXPERIENCE.

Physical Requirements

• ABILITY TO WORK EFFECTIVELY IN A FAST-PACED ENVIRONMENT.
• PHYSICAL ABILITY TO SIT, PERFORM DATA ENTRY AND VIEW COMPUTER SCREEN FOR LONG PERIODS AT A TIME.
• OCASIONAL EXPOSURE TO COMMUNICABLE DISEASES AND BIOHAZARDS.
• DAILY STANDING, WALKING, BENDING, AND MANEUVERING.
• MAY REQUIRE LIFTING UP TO 50 POUNDS OR MORE TO TRANSFER AND/OR TURN PATIENT WITH AND WITHOUT ASSISTIVE DEVICES.

Travel

• TRAVEL MAY BE REQUIRED.

Scheduled Working Hours

• NORMAL WORK HOURS ARE 8:00 A.M. TO 5:00 P.M., MONDAY THROUGH THURSDAY AND 8:00 A.M. TO 1:00 P.M. ON FRIDAYS.
• HOURS MAY VARY DEPENDING UPON THE NEEDS OF THE POSITION, DEPARTMENT, AND CLINIC.

Other Duties

• Please Note This Job Description Is Not Designed To Cover Or To Contain A Comprehensive Listing Of Activities, Duties, Or Responsibilities That Are Required Of The Employee For This Job.