Prior Authorization Coordinator

Upstate Medical University · Greater Syracuse-Auburn Area · 1 wk ago

OTHRFull-time

About the role

Review and evaluate outpatient take-home medications to assure the appropriateness and medical necessity of medication use based on established criteria. Obtain prior authorization from intermediaries and payers, including managed care companies, insurance companies, and review organizations. Ensure completion of activities that maximize revenue capture for high-cost medications.

Conduct prospective prior authorization services to expedite clinic workflow and enhance patient care by preventing therapy interruptions due to insurance paperwork issues. Improve patient service experience and Upstate Medical University Hospital retail pharmacy revenue through provision of prior authorization services at Upstate Medical University Hospital clinics.

Observe and understand prescribing trends within Upstate University Hospital clinics to identify areas for improved specialty pharmacy contracting. Develop an effective working relationship with external entities. Refer appropriate patients to the Medication Assistance Program (MAP). Identify self-pay patients eligible for enrollment into the MAP and coordinate enrollment with the MAP staff.

Work location may vary to any Upstate pharmacy location within Onondaga County based on operational need.

Responsibilities

Review and evaluate outpatient take-home medications for appropriateness and medical necessity.
Obtain prior authorization from intermediaries, payers, managed care companies, insurance companies, and review organizations.
Maximize revenue capture for high-cost medications.
Conduct prospective prior authorization services to expedite clinic workflow and prevent therapy interruptions.
Improve patient service experience and retail pharmacy revenue through prior authorization services.
Analyze prescribing trends to identify areas for improved specialty pharmacy contracting.
Develop working relationships with external entities.
Refer patients to the Medication Assistance Program (MAP) and coordinate enrollment for self-pay patients.

Requirements

Four (4) years of experience in a similar prior authorization role required.
Alternatively, an Associates Degree and 2 years of experience in a similar prior authorization role will be considered.
Excellent written and oral communication, interpersonal, organizational, and conflict resolution skills.
Strong computer skills.

Preferred Qualifications

Experience with medication reimbursement, medications, physician orders, and insurance claim submission.
Experience with healthcare insurance prior authorization, coding, and performing insurance carrier or managed care review.
National Pharmacy Technician Certification.
LPN (Licensed Practical Nurse) certification.

Schedule