Prior Authorization Coordinator - Pharmacy Technician 1 in Portland, Oregon at Portland, OR (South East)

• Determine patient eligibility and benefits for specific medications by contacting insurance providers.

• Collect required demographic, clinical, and insurance details from patients, physicians, and clinical staff to support authorization requests.

• Initiate, submit, and track prior authorization requests through various portals and systems, ensuring timely processing by the insurance company.

• Act as a liaison between patients, referring physicians, clinical staff, and insurance companies to communicate status updates, resolve discrepancies, and provide requested information.

• Follow up on denied claims, gather additional documentation, and coordinate with the clinical team to file appeals and secure approvals.

• Maintain clear and accurate logs of all authorization attempts, communications, decisions, and approvals in patient records and organizational databases.

• Adhere to strict HIPAA regulations and company policies to protect patient information and ensure the privacy and security of all data.

Job Related Knowledge, Skills and Abilities (Competencies):

• Must possess computer keyboarding skills.

• Excellent interpersonal communication
• Knowledge base of insurance reimbursement.
• Knowledge of managed care environment.
• Successfully completes initial and continued competencies as required for maintenance of standard of practice, legal regulatory compliance, and OHSU policies.

• Formal pharmacy technician training program
• Oregon Board of Pharmacy Certified Technician license
• Inpatient and outpatient hospital pharmacy experience.
• Medical and scientific nomenclature.