Medication Authorization Specialist

Medication Authorization Specialist

Location: Rochester General MOB (1415 Portland Avenue, Rochester, NY 14621)

Department: Pharmacy

Hours Per Week: 20 Hours, Part-time

Schedule: Monday, Tuesday and Thursday 8a-4p or 8:30a-5p

Key Responsibilities:

• Coordinate and submit medication prior authorization requests to insurance companies, ensuring timely approvals.
• Monitor, track, and follow up on prior authorizations, step therapy requirements, and appeals processes.
• Communicate with providers to obtain necessary clinical documentation for insurance submissions.
• Assist patients in applying for pharmaceutical assistance foundation programs, grants, and/or co pay programs
• Maintain up-to-date knowledge of manufacturer support programs and eligibility requirements.
• Track patient enrollment status and renewal needs for financial programs.
• Contact patients to explain coverage decisions, out-of-pocket costs, and available financial options.
• Provide empathetic, patient-centered support to help navigate financial barriers to care.
• Serve as a key point of contact for patients regarding their cardiology medication access issues.
• Document all activities accurately and timely in the Electronic Health Records (EHR)
• Work collaboratively with physicians, nurses, pharmacists, and administrative staff to streamline access workflows.
• Participate in process improvement initiatives to enhance patient experience and medication access efficiency.
• All other duties as assigned.

Preferred Qualifications:

• Associates Degree in healthcare administration or business preferred.
• Experience with prior authorizations, pharmacy or specialty medications preferred.
• Proficiency in electronic medical records (EMR) systems and Microsoft Office applications.
• Excellent communication skills including both oral and written as well as interpersonal skills.
• Ability to handle simultaneous tasks paying great attention to detail.
• Flexibility and ability to work as a team player.
• Understanding of managed care, formularies, and payer policies.
• Experience with Electronic Health Records (EHR) systems.
• Strong verbal and written skills for interacting with providers, patients, and insurers.
• Ability to pay attention to detail and ability to manage high volumes of requests with accuracy.

Minimum Qualifications:

• 2 years work experience in a healthcare settings, medical billing, pharmacy, or insurance verification.

Required Licensure/Certification:

• N/A

EDUCATION:

LICENSES / CERTIFICATIONS:

PHYSICAL REQUIREMENTS:

M - Medium Work - Exerting 20 to 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to move objects; Requires frequent walking, standing or squatting.

For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements.

Any physical requirements reported by a prospective employee and/or employee's physician or delegate will be considered for accommodations.

PAY RANGE:

$18.00 - $25.00

CITY:

Rochester

POSTAL CODE:

14621

The listed base pay range is a good faith representation of current potential base pay for a successful full time applicant. It may be modified in the future and eligible for additional pay components. Pay is determined by factors including experience, relevant qualifications, specialty, internal equity, location, and contracts.

Rochester Regional Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, sex (including pregnancy, childbirth, and related medical conditions), sexual orientation, gender identity or expression, national origin, age, disability, predisposing genetic characteristics, marital or familial status, military or veteran status, citizenship or immigration status, or any other characteristic protected by federal, state, or local law.