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Utilization Management Specialist

Amber Pharmacy locationOmaha, NE
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7 positions
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Web Mktg Technology Specialist

Amber Pharmacy locationOmaha, NE
7 positions
info linkReport a probelm Originally Posted : July 20, 2021 | Expires : August 19, 2021

Details

Job Type
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Custom
Salary
Unspecified
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Utilities
Utility - Billing
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Job Location
Omaha, NE, United States

Description

Amber Specialty Pharmacy is a rapidly growing specialty pharmacy serving patients across the country! We were founded in Omaha, Nebraska and maintain our headquarters here. During 2020 we opened 9 new pharmacy locations from Maine to Mississippi- joining our existing 12 locations from California to Virginia. Our employees are professionals whose services and expertise earned us the 2020 Specialty Pharmacy of the Year Award from the National Association of Specialty Pharmacy.

As an employee of Amber Specialty Pharmacy you have an attractive core benefit plan, plus extras like paid parental leave, competitive 401(k) match and vesting period, and paid time off. Learn more about the need for another Utilization Management Specialist below:

Primary Responsibilities:
1. Initiates and completes prior authorizations and appeals for specialty pharmacy
3. Work directly with providers, health plans, PBM’s, and other specialty pharmacies to relay vital information and provide a high level of service
4. Communicates with providers, health plans, PBM’s, and patients to obtain status of pending prior authorizations and appeals.
5. Submits prior authorization and/or appeal requests via electronic, phone or fax on behalf of physicians/providers as allowed.
6. Assures that all prior authorization and appeal documents, databases and records are maintained accurately and in a timely fashion.
7. Evaluate and process claims rejecting for prior authorization in accordance with company policies and procedures
8. Advocates on the patient’s behalf to identify and assess coverage issues.
9. Assists licensed professional in the review of patient chart notes and payer requirements to determine why cases an appropriate course of action.
10. Assures timeliness and appropriateness of all PA requests and provider appeals according to state and federal and company guidelines.
11. Adheres to all company policies as indicated in the handbook and directives issued by management. Has reviewed Accreditation Policy and Procedure manual.
12. This is an office based position.


Professional Competencies:

  • Proficient with MS Excel, Word, and Outlook
  • Understanding of insurance verification and online prescription adjudication
  • Strong oral, written, and interpersonal skills
  • Demonstrated ability to meet tight deadlines
  • Ability to work with all levels of internal management and staff, as well as outside clients and vendors
  • Working knowledge of Medicare, Medicaid, and Commercial Insurance and renal programs related to pharmacy, billing, grants, copay cards, prior authorizations, and rejections.
  • Prior PAP, PA and co-pay card experience preferred
  • Prior experience trouble shooting rejected pharmacy claims preferred
  • Proficiently read and understand abstract information from handwritten patient medical records.


Required Qualifications:
Working knowledge of the healthcare industry
HIPAA trained and /or the ability to work with and protect extremely confidential patient and employee information
Six months or less of similar or related work experience


Educational Requirements:
High school diploma or equivalent


Licensure and Certification Requirements:
Nationally Certified Pharmacy Technician preferred

We exist today because our employees refuse to compromise the patient experience and continue to provide the best customer service regardless of the circumstances. Amber Specialty Pharmacy is a growing company with a bright future. If you share a passion for healthcare, specialty pharmacy, or making a difference in the lives of patients, apply to join us today.

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Amber Pharmacy

Pharmaceuticals/Medical
7 active jobs
locationOmaha, NE
clockFull-time
locationOmaha, NE
clockFull-time
locationOmaha, NE
clockFull-time
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