Authorization Specialist II

CarepathRx transforms hospital pharmacy from a cost center into an active revenue generator through a powerful combination of technology, market-leading pharmacy services and wrap-around services.

Job Details:

This position is responsible to oversee the requesting and obtaining authorizations for specialty and infusion pharmacy. Manage the review of initial prior authorization requests and renewal authorizations. Collaborate with clinicians regarding supporting medical documentation in accordance with formulary guidelines. Manage the quality review of requested prior authorizations. Additional responsibilities include orientation and mentoring new staff and daily oversight of team members. Also, monitoring the performance of the authorization team and create and update policies and procedures.
 

Responsibilities

• Oversees and maintains expertise in assigned areas of specific responsibility such as formulary exceptions, prior authorization requirements and time frames according to line of business and payer. Ensures initial and renewal authorizations are followed up on appropriately.

• Directs the daily operations/workflow of the authorization specialist in accordance with patient care needs, department strategic plan, and appropriate accreditation standards.

• Create work schedules, implement guidelines, conduct staff meetings and update personnel on company updates i.e., internal processes and contracts.

• Manage recruitment, hiring, training, evaluation, and competency of personnel; maintains a quality workforce.

• Monitors performance and compliance of reporting personnel and provides feedback via performance evaluations and disciplinary action when necessary. Initiates disciplinary action and makes recommendations for corrective action and improvement of performance

• Ensure achievement of productivity standards and adherence to regulations and standards of performance and accreditation. Collaborate with the team to identify efficiencies.

• Acts as a resource to all personnel to resolve problems and answer questions regarding intake operations. Takes the initiative to present ideas/suggestions to management.

• Performs in accordance with system-wide competencies/behaviors.

• Performs other duties as assigned.

Skills & Abilities

• Excellent written and verbal communication

• Organized

• High Integrity

• Interpersonal skills

• Adaptability

• Time Management

• Conflict resolution

Qualifications

• HS diploma or GED required

• 2+ years of pharmacy claims, pharmacy tech, and/or other related experience in a physician practice, ancillary provider, or other relevant healthcare setting, preferred

• Knowledge of medical terminology, coordination of benefits

• Knowledge of payer websites preferred

• Knowledge of medical terminology preferred

• Knowledge of pharmacy payers and authorization requirements preferred

• Proficient computer skills and Microsoft Office Products, preferred Excellent customer service skills

• Self-starter with the ability to work with minimum supervision

CarepathRx offers a comprehensive benefit package for full-time employees that includes medical/dental/vision, flexible spending, company-paid life insurance and short-term disability as well as voluntary benefits, 401(k), Paid Time Off and paid holidays. Medical, dental and vision coverage are effective 1st of the month following date of hire.

CarepathRx provides equal employment opportunity to all qualified applicants regardless of race, color, religion, national origin, sex, sexual orientation, gender identity, age, disability, genetic information, or veteran status, or other legally protected classification in the state in which a person is seeking employment. Applicants encouraged to confidentially self-identify when applying. Local applicants are encouraged to apply. We maintain a drug-free work environment. Applicants must be eligible to work in this country.