Pharmacy Based Prior Authorization Specialist

hace 3 días

O Hospital, España Wyandot Memorial Hospital A tiempo completo

Join our team at Wyandot Memorial Hospital, where you'll find a supportive, community-focused environment, excellent benefits, and the opportunity to make a real difference in the lives of our patients. Be part of a dedicated team that values teamwork, professional growth, and a strong commitment to compassionate, high-quality care.

The Pharmacy-Based Prior Authorization Specialist position is part of the Pharmacy Department and is a full-time role working 80 hours per two-week pay period. Standard working hours are 8:00 AM – 4:30 PM, Monday through Friday. This role plays an essential part in ensuring patients receive timely access to prescribed medications by coordinating and managing the insurance pre-approval process for specific medications and treatments. The specialist verifies coverage requirements, submits detailed documentation, and communicates with clinical staff, pharmacies, and insurance providers to resolve issues or denials. The specialist will be registered with the Ohio Board of Pharmacy as a Registered Pharmacy Technician within 12 months of employment. Qualifications
  • High school diploma or equivalent; pharmacy technician education or experience preferred
  • Registration with the Ohio Board of Pharmacy as a Registered Pharmacy Technician (or ability to obtain within 12 months)
  • Strong knowledge of pharmaceuticals, medical terminology, and insurance processes
  • Excellent written and verbal communication skills
  • Detail-oriented with strong organizational and documentation skills
  • Proficient with electronic medical records (EMR) systems and insurance portals
  • Ability to collaborate with clinical staff, providers, and pharmacies to resolve issues
  • Knowledge of 340B program, GPO contracts, and pharmacy inventory management preferred
Key Responsibilities
  • Review and analyze patient prescriptions and medical records to determine if prior authorization is required
  • Submit prior authorization requests to insurance providers with all required documentation and clinical justification
  • Communicate with healthcare providers, patients, and pharmacies to gather information and resolve denials
  • Assist in the appeals process for denied authorizations, including documentation and letters of medical necessity
  • Maintain accurate records of all prior authorization activities to ensure regulatory compliance and confidentiality
  • Anticipate prescription refills to avoid therapy disruptions
  • Collaborate with pharmacy staff across WMH locations to ensure timely patient care and adherence to protocols
  • Provide oversight of drug ordering, receiving, storage, and inventory management for related medications
  • Manage 340B program compliance, including split billing, procurement, and recordkeeping
  • Support alternative distribution model drug ordering, tracking, and shipping to secondary sites
  • Monitor financial parameters for pharmacy programs to remain within budget
  • Stay current on insurance policy changes, coverage criteria, and pharmacy benefit updates
  • Educate staff on prior authorization procedures, software use, and patient access processes

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