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Authorization Specialist / Pharmacy; Bonus $1500*/FT; Mon - Fri; 8:00 to 4:30

Children's Hospital & Medical Center - Omaha locationOmaha, NE
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276 positions
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276 positions
info linkReport a probelm Originally Posted : January 05, 2022

Details

Salary
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Job Location
Omaha, NE, United States

Description

FT; Mon - Fri; 8:00 to 4:30; Sign-on Bonus $1500 (external candidates only)

Were searching for an Authorization Specialist to be responsible for pre-certification of outpatient medications on behalf of Children's Hospital & Medical Center and designated physicians with third party payers related to medication authorizations. Establishes good rapport with and maintains effective communications with patients, their parents, physicians, nursing staff and third-party payors.

Essential Functions

  • Subject matter expert in prior authorization of medications and acquisition of specialty medications.
  • Primarily responsible for coordinating the authorizations of outpatient medications for the Specialty Pediatric Center clinics.
  • Obtains pertinent information and necessary documentation from referring provider and/or Specialty Physician when required by payors, for the authorization of medication.
  • Documents the medication authorization and associated documentation in EPIC.
  • Coordinates, prioritizes, and process outpatient medication authorizations utilizing Epic, Surescripts, Right Fax, and other appropriate software and electronic resources.
  • Monitors Epic work queues, Right Fax inbox, and shared prior auth email for outpatient medications that need an authorization.
  • Consults with referring/ordering physician, pharmacists, and Access when insurance authorization or coverage is in question
  • Utilizes Epic work queues when processing medication authorizations.
  • Follows standard operating procedure with respect to approvals, denials, and appeals.
  • Tracks follow-up dates according to initial authorization utilizing Epic software.
  • Obtains and maintains knowledge of requirements for third party payers.
  • Obtains and maintains knowledge of requirements for specialty pharmacies.

KNOWLEDGE, SKILLS AND ABILITIES

  • Good verbal & written skills
  • Computer knowledge
  • Ability to work with minimal supervision
  • Knowledge of ICD-9, ICD-10, HCPCS and CPT-4 coding regulations
  • Knowledge of the changing rules and regulations of third-party payors
  • Knowledge of the changing rules and regulations of specialty pharmacies
  • Problem solving skills

EDUCATION AND EXPERIENCE

  • High School Diploma or G.E.D. required
  • Associates degree from an accredited college or university in a healthcare field preferred.
  • Minimum two years experience in authorizations, medical office setting, or health insurance setting required

CERTIFICATIONS/LICENSURE REQUIREMENTS

  • Current and valid registration as a Pharmacy Tech with the State of Nebraska is preferred.

EOE/Vets/Disabled

IND123

About Children's Hospital

When you work at Childrens, youre part of a treasured place of healing in the Omaha communityand beyond. Join our team of highly engaged, caring professionals who believe deeply in the organizations missionto improve the life of every child. We support equity, diversity and inclusion, and as you apply your skills and expertise to helping children, you too will have opportunities to grow your career. In 2021, well open the new Hubbard Center for Children, tripling our capacity to serve children.

When children are your everything, anything can be

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Children's Hospital & Medical Center - Omaha

Health Care/Wellness/Fitness
276 active jobs
locationOmaha, NE
clockFull-time
locationOmaha, NE
clockFull-time
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