Grant Specialist, Authorization Management

Additional Considerations (if any):

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At Amber Specialty Pharmacy, our commitment to patient care is unmatched. Enjoy fulfillment in a career where you have the opportunity to make a positive impact on patients with complex and chronic conditions.

• Monday-Friday (no weekends)
• Hours: 8 a.m. - 5 p.m. CST
• Wages: Hourly $19.00 to $20.00
• Six paid holidays
• Must pass post-offer, pre-employment drug background tests as allowed by state, federal, local ordinance, statutes and licensing/accreditation requirements.

Job Title: Grant Specialist Authorization Management Specialist

Department: Operations

FLSA: Non-Exempt

General Function:

The Prior authorization team is responsible for ensuring that critical patient information is collected, analyzed, and responded to, initiating and completing appeals on rejected claims, and obtaining authorization to fill prescriptions. The Grant Specialists' primary focus will be addressing claims (patients) who have been denied payment by the pharmacy, investigating and ensuring the application for Patient Assistance and co-pay cards are utilized, and exploring financial assistance while communicating with key parties, i.e., prescriber offices. All processes are recorded in the electronic medical record. The job is to find alternative means or appeal denials to patients awaiting their prescriptions in a time-sensitive manner.

Reporting Relations:

Reports to: Authorization Management Specialist, Lead

Direct Reports: N/A

Primary Responsibilities:

• Provide support for Amber Pharmacy and Hy-Vee Pharmacy Solutions (HPS).

• Must maintain the established workflow within the department and adhere to the company/department’s Policy and Procedure manual, including the follow-up policy.

• Researches and applies to Patient Assistance Programs (PAP) for needy patients.

• Contact patients and refer clients regarding PAP application and process or reject issues as applicable.

• Distributes and communicates information regarding PAPs and rejects to appropriate internal departments.

• Ensures that PAP applications are complete and accurate before submission to PAP Foundations, when applicable.

• Responsible for checking remaining grant amount, grant expiration dates, renewal of PAPs when applicable, and updating the PAP grant tracking spreadsheet from the daily report.

• Creates reports pertaining to PAP’s and prior authorizations.

• Tracks input of all PAPs and copay cards worked on appropriate spreadsheets.

• Reverses or voids all test claims.

• Informs appropriate internal departments of any patient/referring client circumstance that could become a problem.

• Initiates and completes prior authorizations and appeals for specialty pharmacy.

• Work directly with providers, health plans, PBMs, and other specialty pharmacies to relay vital information and provide a high level of service.

• Communicates with providers, health plans, PBMs, and patients to obtain the status of pending prior authorizations and appeals.

• Submits prior authorization and appeal requests via electronic, phone, or fax on behalf of physicians/providers as allowed.

• Assures that all prior authorization and appeal documents, databases, and records are maintained accurately and timely.

• Evaluate and process claims rejected for prior authorization following company policies and procedures.

• Advocates on the patient's behalf to identify and assess coverage issues.

• Assists licensed professionals in reviewing patient chart notes and payer requirements to determine why cases are an appropriate course of action.

• Assures timeliness and appropriateness of all PA requests and provider appeals according to state, federal, and company guidelines.

Professional Competencies:

• Proficient with MS Excel, Word, and Outlook

• Understanding of insurance verification and online prescription adjudication

• Strong oral, written, and interpersonal skills

• Self-initiative

• Demonstrated ability to meet tight deadlines

• Ability to work with all levels of internal management and staff, as well as outside clients and vendors

• Working knowledge of Medicare, Medicaid, Commercial Insurance, and renal programs related to pharmacy, billing, grants, co-pay cards, prior authorizations, and rejections.

• Prior PAP, PA, and co-pay card experience preferred

• Previous experience troubleshooting rejected pharmacy claims preferred

• Proficiently read and understand abstract information from handwritten patient medical records

Required Qualifications:

• Working knowledge of the healthcare industry

• HIPPA trained and/or the ability to work with and protect highly confidential patient and employee information

• Six months or less of similar or related work experience

Educational Requirements

• High school diploma or equivalent

Licensure and Certification Requirement:

Not required

• Nationally Certified Pharmacy Technicians preferred

• Application for certification within state-specified criteria

Physical Requirements:

• Must be able to remain in a stationary position –up to 90% of the time

• The person in this position must occasionally move inside the office to access file cabinets, machinery, etc., and traverse conferences, meetings, and remote events.

• Constantly operates a computer and other office productivity machinery, such as a calculator, copy machine, and computer printer.

• The ability to communicate information and ideas so others will understand. Must be able to exchange accurate information in these situations.

• The ability to observe details at close range (within a few feet of the observer).

Working Conditions:

• Normal office environment.

Equipment Used to Perform the Job:

• Computers, keyboards, mouse, monitors, faxes, and or headsets for phone work. Software specific to the position, including but not limited to Microsoft Outlook and Skype. Must lift and traverse the area to move paper and supplies to use the equipment.

Contacts :

• Frequently interact with co-workers, internal company staff, managers, leaders, insurance providers, payers, vendors, and customers. This is not an exhaustive list of contacts and is subject to changes and alternatives.

Confidentiality :

• The incumbent must maintain the confidentiality of personal information for the applications and licensing requirements, including any financial, strategic, or proprietary information. The Company does not consider this an exhaustive list of examples and may add or modify as deemed appropriate to the execution of the role.

This is not intended to be an all-encompassing list of duties. The job mentioned above is to be used as a guide to assist in accomplishing company objectives, covering only primary functions and responsibilities. Amber Specialty Pharmacy/Hy-Vee Pharmacy Solutions retains the right to change or assign other duties to the job.

Candidates must be able to pass a pre-employment drug test, background check, and health screening (if applicable).

Apply now and join our mission to provide exceptional patient care!