Pharmacy Tech III - Prior Auth in Kansas City, Missouri at North Kansas City Hospital

JOB DESCRIPTION

SUMMARY: As an integral member of the pharmacy team and under the supervision of a pharmacist, the prior authorization pharmacy technician is responsible for providing clinicbased prior authorization support and improving patient care fragmentation, so patients can obtain their medication timely. These efforts lead to increased patient adherence and satisfaction which subsequently result in an improved quality of life as well as patient outcomes. The position allows for a workload shift to an appropriate skill mix improving provider, nursing, and office staff satisfaction as more time is available for direct patient care related activities. The individual will also perform all required technical functions within the pharmacy department to assist in providing quality pharmaceutical care to patients as needed. The prior authorization technician may provide services within the scope of their license, certification, registration, and/or assessed competencies. Practice will be in accordance with laws and regulations. EXPERIENCE: Required: Minimum three (3) years of experience in healthcare or related field. Preferred: Two (2) years of experience working with managed care insurance companies and/or Medicare/Medicaid. Two (2) years of experience working with medical, and pharmacy benefit prior authorization process. Two (2) years of experience working with manufacturers provided free drug programs. Two (2) years of experience working with specialty pharmacy processes. OTHER: Maintain technician licensure and credentials in good standing and maintain continuing education credits as required by Missouri Board of Pharmacy & Pharmacy Technician Certification Board, and any other regulatory agencies.

LICENSURE/CERTIFICATIONS

(1&2) Required: CPhT (Certified Pharmacy Technician), PTCB (Pharmacy Technician Certification Board)

EDUCATION

Required: High School or Equivalent, Preferred: Associates Related Field, Bachelors Related Field

JOB STANDARDS

Conduct patient scheduling process by receiving referrals, screening patient demographic information, conducting benefits investigation, and determining payer coverage. Documents formal notes in the electronic medical record where appropriate, documenting the findings of the prior authorizations

Provide specialized information on a variety of matters relating to the processing of prior authorizations. Contact payers and obtain prior authorizations that meet payer criteria for access. As necessary, outline how long it will take to review and approve/deny the prior authorization. Ensure insurance coverage requests are submitted along with all necessary documentation. Prospectively complete reauthorization of expiring prior authorizations for patients that will be continuing therapy.

Validate benefit information before a patient arrives for an appointment and verify details thoroughly to ensure a comprehensive claims process that helps prevent revenue loss and enhances fiscal stability.

Coordinate the processing, distribution, and delivery of referrals while maintaining product integrity, managing inventory of specialty medications, following up with patients to ensure that they receive medications, and billing for services rendered.

Identify copay assistance for medications including manufacturer copay cards or foundation assistance. Act as a liaison for manufacturer provided medication assistance programs for healthcare staff and patients. Identifies all qualified medication assistance program participants in accordance with eligibility requirements.

Other duties as assigned.