Pharmacy Authorization & Financial Coordinator

Job Description

Job Description

Oklahoma Arthritis Center (OAC) is an Equal Employment Opportunity employer and considers all applicants without regard to race, religion, color, sex, national origin, age, disability, veteran status, or any other legally protected status.

 

Job Summary:

Working as a part of the Pharmacy Financial Coordinator team, this employee will be responsible for reviewing eligibility and benefits, obtaining required authorizations, communicating patient authorizations outcomes, guiding patients towards appropriate copay assistance needs, and performing all financial coordination functions for ancillary services. Additionally, this team member works closely with providers and other clinic staff to ensure that medications, for which authorizations obtained, were successfully filled by appropriate pharmacy and obtained by patient.

Essential Functions:

• Verifies prescription benefits and eligibility. Submits prior authorizations for medications and follows up in a timely manner.
• Reprocesses insurance claims for medications as needed
• Communicates with patient on authorization status, outcome, and any individual needs to obtain medication.
• Researches and follows PBM guidelines and policies.
• Resolves issues that inhibits patient from obtaining prescription medications ordered by their clinic provider.
• Answers phone calls and returns voicemails in a timely manner.
• Resolves assigned tasks in the Electronic Health Record.
• Adheres to compliance of OAC policies and standard operating procedures.
• Sets the standard for the team by providing excellent patient care.
• Offers other team members assistance as needed.
• Maintains open and positive lines of communication, and functionality.
• Understands and adheres to HIPAA laws and regulations in compliance and patient confidentiality.

 

Performance Requirements:

 

Knowledge: 

• Knowledge of Pharmacy claim rejections and prior authorizations.
• Knowledge of Medicare, Medicaid, and Commercial PBMs.
• Knowledge of insurance plan formularies and step therapy guidelines.
• Knowledge of brand/generic conversions and proficient in pharmacy math calculating dose or day supply.
• Knowledge of prescription medications and their FDA approved use and dosage.
• Knowledge of Oklahoma State Pharmacy Board rules and regulations.
• Proficient in CoverMyMeds, EHR systems, and Microsoft Office.

 

Skills:

• Excellent customer service skills.
• Clinical, analytical and problem solving skills.
• Ability to recognize, evaluate, and correct errors.
• Ability to establish priorities and coordinate work activities.

 

Abilities: 

• Attention to detail.
• Able to type 50 words per minute.
• Office (Outlook, Word, Excel, PowerPoint).

 

Qualifications:

• 1-2 years of experience with pharmacy billing, insurance, prior authorizations, medical billing, or a related field preferred.
• 2+ years’ experience as Pharmacy Technician.
• High school diploma or equivalent.
• Oklahoma pharmacy tech license - required.
• Specialty pharmacy experience – preferred.
• Liberty experience – a plus.
• EHR system experience.

Physical Requirements:

• Ability to work effectively in a fast-paced environment.
• Physical ability to sit, perform data entry and view computer screen for long periods at a time.
• Occasional exposure to communicable diseases and biohazards.
• Daily standing, walking, bending, and maneuvering.
• May require lifting up to 50 pounds or more to transfer and/or turn patient with and without assistive devices.

Travel:
Travel may be required.

Scheduled Working Hours:
Normal work hours are 8:00 a.m. to 5:00 p.m., Monday through Thursday and 8:00 a.m. to 1:00 p.m. on Fridays. Hours may vary depending upon the needs of the position, department, and clinic.

 

Other Duties:

Please note this job description is not designed to cover or to contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change from time to time, with or without notice.

 

Equipment Operated:

Standard office equipment including: computers, printers, faxes, copiers, postage machine, etc.