Authorization Management Specialist

Additional Considerations (if any): - At Amber Specialty Pharmacy, our commitment to patient care is unmatched. Enjoy fulfillment in a career where you have the opportunity to make a positive impact on patients with complex and chronic conditions. Monday-Friday (no weekends) Hours: 8 a.m. - 5 p.m. CST Wages: Hourly $19.00 to $20.00 Six paid holidays Must pass post-offer, pre-employment drug background tests as allowed by state, federal, local ordinance, statutes and licensing/accreditation requirements. Amber Specialty Pharmacy

Job Title: Authorization Management Specialist Department: Operations FLSA: Non-Exempt

General Function Responsible for preparing appeal summaries and prior authorizations, correspondence with prescriber's offices, and documenting information in the electronic medical record. Gathers pertinent patient history and information, evaluates information, prepares responses, and completes appeals and prior authorizations accurately and timely . Reporting Relations Reports to: Authorization Management Specialist, Lead Direct Reports: None Primary Duties and Responsibilities : Initiates and completes prior authorizations and appeals for specialty pharmacy Work directly with providers, health plans, PBMs, and other specialty pharmacies to relay vital information and provide

a high level of service Communicates with providers, health plans, PBMs, and patients to obtain the status of pending prior authorizations and appeals Submits prior authorization and/or appeal requests via electronic, phone , or fax on behalf of physicians/providers as allowed Assures that all prior authorization and appeal documents, databases , and records are maintained accurately and timely Evaluate and process claims rejected for prior authorization following company policies and procedures Advocates on the patient' s behalf to identify and assess coverage issues Assists licensed professional s in reviewing patient chart notes and payer requirements to determine why cases are

an appropriate course
of action
Assures timeliness and appropriateness of all PA requests and provider appeals according to state, federal,
and company guidelines
Adheres to all company policies as indicated
in the handbook and directives issued by management. Has reviewed Accreditation Policy and Procedure manual
Professional Competencies
:
Proficient with MS Excel, Word, and Outlook
Understanding of insurance verification and online prescription adjudication
Strong oral, written, and interpersonal skills
Self-initiative
Demonstrated ability to meet tight deadlines
Ability to work with all levels of internal management and staff, as well as outside clients and vendors
Working knowledge of Medicare, Medicaid, Commercial Insurance,
and renal programs related to pharmacy, billing, grants, co
-
pay cards, prior authorizations, and rejections
Prior PAP, PA,
and co-pay card experience preferred
Previous
experience troubleshooting rejected pharmacy claims preferred
Proficiently read and understand abstract information from handwritten patient medical records

Required Qualifications: Working knowledge of the healthcare industry
HIPPA trained and/or the ability to work with and protect
high
ly confidential patient and employee information
Six months or less of similar or related work experience

Educational Requirements

High school diploma or equivalent

Licensure and Certification Requirement: Nationally Certified Pharmacy Technician
s
preferred
Application for certification within state-specified criteria

Physical Requirements: Must be able to remain in a stationary position up to 90% of the time
The person in this position must occasionally move inside the office to access file cabinets, machinery, etc., and traverse conferences, meetings, and remote events
Constantly operates
a computer and other office productivity machinery, such as a calculator, copy machine, and computer printer
The ability to communicate information and ideas so others will understand. Must be able to exchange accurate
information in these situations
The ability to observe
details at close range (within a few feet of the observer)

Working Conditions
:
Normal office environment.

Equipment Used to Perform the Job
:
Computers, keyboards, mouse, monitors, fax, and/or headsets for phone work.
Software specific to the position, including but not limited to Microsoft Outlook and Skype.
Must lift and traverse the area to move paper and supplies to use the equipment.
Contacts
:
Frequently interact with co-workers, intradepartmental staff of the Company, managers, leaders, insurance providers, payers, vendors, and
customers.

This

is not an exhaustive list of contacts and is subject to changes and alternatives.

Confidentiality

:

The incumbent must maintain the confidentiality of personal information for the applications and licensing requirements, including any financial, strategic, or proprietary information. The Company does not consider this an exhaustive list of examples and may add or modify as deemed appropriate to the execution of the role. Candidates must be able to pass a pre-employment drug test, background check, and health screening (if applicable). Apply now and join our mission to provide exceptional patient care!