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.
- 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
- Current and valid registration as a Pharmacy Tech with the State of Nebraska is preferred.
Children's Hospital & Medical Center - Omaha