Job description
In general, a Pre-Authorization Coordinator will be responsible for the following tasks:
Other duties: Perform or assist with any operation, as necessary to maintain the workflow and to comply with schedules and quality requirements; Participate in meetings and work groups prepared by management or co-workers. Be knowledge related to new developments, requirements and policies. The P-AC’s goal is to ensure patient satisfaction through personal attention, and an efficient, transparent and simple process from end to end.
Experience:
- Gather ALL necessary information and supporting documents to comply with MCO requests in order to promptly determine treatment Authorization or Denial.
- Contact insurance companies or other payers to complete prior authorization requirements, identify the co-payment structure and investigate coverage and benefits;
- Communicating with patients to inform co-pay/deductible amount. and informing about Patient Assistance Programs (PAP). Referring to PAP, as appropriate.
- Conduct benefit coordination on behalf of patients, when applicable
- Determine patient eligibility
- Request authorization modifications, as needed.
- Index documents in patients’ records in a timely manner
- Respond to incoming calls with excellent customer service standards and following up with pending tasks (internal or external);
- Meet management’s production standards, whether quantitative or qualitative
Other duties: Perform or assist with any operation, as necessary to maintain the workflow and to comply with schedules and quality requirements; Participate in meetings and work groups prepared by management or co-workers. Be knowledge related to new developments, requirements and policies. The P-AC’s goal is to ensure patient satisfaction through personal attention, and an efficient, transparent and simple process from end to end.
Experience:
- Experience working with pre authorization processes or health plans is preferred.
- Exemplary communication skills, customer service, and skills to build customer relationships; including listening, speaking and writing.
- Consistent focus and attention to detail resulting in superior accuracy.
- Demonstrate organizational capacity, and ability to prioritize tasks according to company policy
- Clear and consistent understanding of health care protocols for privacy.
- Demonstrate competence in pharmaceutical applications and in the management of computers with knowledge of office software, including MS Word and Excel (preferably CPR +).
- May require a demonstrated knowledge of the medications used for therapy in defined disease states served by the assigned pharmacy.
- Associate Degree Diploma with valid license as Pharmacy Technician is required.
- Minimum 1-year experience in customer service with knowledge of access processes to the most preferred benefits.
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