Job Purpose:

The Authorization Specialist  is responsible for verifying patient’s eligibility, coordinating medical benefits, gaining approval for planned procedures and services.

The In-Office Dispenser under the supervision of a physician supports pharmacy services assisting with oversight, monitoring, preparation, dispensing and proper documentation of patient medication therapy.

 Essential Functions:

·         Verify private, government and third party insurance information.

·         Verify any secondary and tertiary medical insurance benefits.

·         Obtain, review and input insurance authorization and referrals prior to patient services and throughout treatment to maintain continuance of authorizations.

·         Advocate for the patient utilizing knowledge of coverage based guidelines and treatments.

·         Monitor and track patient authorizations and communicate changes to the appropriate team members.

·         Identifies and provides accurate CPT/ICD codes where needed for reimbursement.

·         Maintains and submits appropriate logs and reports to professional, state and federal entities as required including, but not limited to; Medicaid and Medicare.

·         Obtains, interprets and submits clinical documentation pertinent to the specific services requiring prior authorization to support medical necessity review by the payer.

·         Follows up on denied authorizations requests and relays the necessary denial detail to the provider to facilitate the appeal and/or peer to peer review .

·         Works closely with Sr. Authorization Specialist.

·         Works closely with the Financial Counselor, Patient Navigator, Nursing and front office staff.

·         Maintains appropriate documentation in the registration and electronic medical record systems.

·         Regular attendance and punctuality.

·         Ensures that all processing and reporting deadlines are consistently achieved.

·         Performs other functions as required by management.

·         Knowledge of medications and their indication, contraindications, dosing, side effects and proper administration and/or ability to learn.

·         Knowledge of accepted medication resources and information databases and/or ability to learn.

·         Reviews medication orders and contacts prescriber for clarification.

·         Preparation, labeling and dispensing of oral medications.

·         Provides drug information as appropriate to patients.

·         Disbursement of prescriptions to non-local patients as needed.

·         Maintains methods and manner of storage and record keeping systems to provide for safekeeping of pharmaceuticals.

·         Inventory control of dispensary medications and supplies.

·         Follows departmental policies, procedures and objectives, continuous quality improvement objectives and safety, environmental and/or infection control standards and patient confidentiality.

 Qualifications and Education Requirements

·         Medical Assistant, LPN or Pharmacy Technician highly preferred

·         Basic PC skills

 Preferred Skills

·         Oncology background

·         Knowledge of ICD9/10 diagnosis codes, CPT codes

·         Basic knowledge of medical/pharmacy terminology

 Required Competencies

Strong business and organizational competence, exceptional customer service skills ,interpersonal skill competency,  adaptability, accountability, integrity, time management skills with an emphasis on multi-tasking