Job Description

Responsible for all aspects of drafting and completing prior authorizations, entering of medication orders and customer service for patients, and working as liaison with pharmacy team and provider offices.

Responsibilities

• Educate prospective pharmacy patients on how the specialty pharmacy serves patients and improves their overall care
• Resolve insurance related issues, complete benefit investigations, including prior authorizations (PAs) as an agent of the provider
• Review the patients need for financial assistance and secure financial assistance when needed and available
• Document patient information within the hospital EMR, QS1, Therigy and all proprietary tools as required
• Secure prescription renewals
• Communicate directly with patients to assist them in the awareness of their medications
• Identify medications requiring special storage and/or handling such as hazardous medications and/or refrigerated medication
• Answer, resolve and triage inbound inquiries
• Apply observations and recommendations to operational issues, increased productivity, quality, and customer-service standards
• Actively participate in process improvement initiatives.
• Responsible for monitoring adjudication queue(s) and facilitate prior authorization process for customers
• Responsible for ensuring a high level of successful prior authorizations
• Responsible for Appeals Requests and External Appeals Requests when necessary.
• Act as liaison with Clinical and Pharmacy Team in communicating with provider offices on questions regarding appropriateness of therapy, labs or other questions/concerns and provide support for prior authorization, financial assistance, and prescription fill and renewal
• Responsible for accurate selecting billing and shipping methods for incoming patient orders
• Document patient reported information into TherigySTM
• Responsible for accurate data entry of incoming prescriptions, if required
• Provides resolution to customer service issues to ensure member satisfaction
• Customer service coverage for incoming calls, and making outbound calls to set up customer deliveries
• Responsible for completing all mandatory and regulatory training programs
• Perform other duties as assigned

Qualifications

Educational Requirements:

• Minimum: High School Diploma or GED
• Preferred: Pharmacy technician or related certification

Experience:

• Experience with Prescription Prior Authorizations required
• 6-12 months experience as a pharmacy technician preferred

Job Skill Requirements:

• Broad knowledge of medications, physician orders, and pharmacy systems
• Familiar with Enterprise billing options and practices surrounding claim submission
• Strong communication skills
• Outstanding customer service skills
• Excellent organization skills
• Ability to multitask and prioritize
• Excellent computer and keyboarding skills

Compensation:

$18.02-27.03 per hour.

The final offer will be determined after careful consideration of multiple factors such as relevant skills, years of experience and education.

KPH Healthcare Services, Inc. is a multistate organization and abides by all local, state and federal regulations as it pertains to minimum wage requirements.