Title: Medication Access Associate - Prior Authorizations
remote type
Remote
locations
Essentia Health Superior Belknap Pharmacy
time type
Full time
job requisition id
R067193
Building Location:
Essentia Health Superior Belknap Pharmacy
Department:
1008850 PRIOR AUTHORIZATION - EH SS
Job Description:
Medication Access Associates work cross-functionally to ensure that patients are receiving the medication therapy they need to achieve optimal care. Primary responsibility will be to facilitate medication prior authorizations via patients’ pharmacy benefits, facilitate authorization of patient prescription refill requests, assist in Medicare Part B billing and processing, and support patient enrollment in financial assistance programs.
Education Qualifications:
Key Responsibilities:
Follow policy and procedures to determine eligibility for prescription refill authorization
Gather necessary insurance information to conduct benefits investigation on prior authorization (PA) requests via a patient’s pharmacy benefits
Interpret PA and appeal requirements and gather all relevant clinical and supporting documentation for submission to third-party payors
Effectively communicate with fellow team members, providers, nursing staff, pharmacies, third parties, and software vendors to work through claims adjudication and processing issues to ensure payment from third-party payers for medications ordered by Essentia providers requiring prior authorization
Understand Medicare Part B DME billing for Essentia retail pharmacies to help ensure Medicare rules are followed when processing Medicare B billed claims
Provide direct patient interaction by assisting patients with manufacturer-based patient assistance programs (PAP) and liaising between patients, providers, and pharmaceutical manufacturers
Other duties as assigned
Required Qualifications:
1 year experience as a pharmacy technician, medical assistant, claims representative in a managed care role or in a coding role
Excellent verbal and written communication skills
Attention to detail and ability to manage multiple tasks simultaneously
Licensed/Certified in field of experience (CPhT, CMA, etc.)
Preferred Qualifications:
2 years’ experience as a pharmacy technician, medical assistant, claims representative in a managed care role or in a coding role
Licensure/Certification Qualifications:
Certification/Licensure Requirements:
Licensed/Certified in field of experience (CPhT, CMA, etc.)
FTE:
1
Possible Remote/Hybrid Option:
Remote
Shift Rotation:
Day Rotation (United States of America)
Shift Start Time:
Shift End Time:
Weekends:
Holidays:
No
Call Obligation:
No
Union:
Union Posting Deadline:
Compensation Range:
$21.49 - $32.24
Employee Benefits at Essentia Health:
At Essentia Health, we’re committed to supporting your well-being, growth, and work-life balance. Our comprehensive benefits include medical, dental, vision, life, and disability insurance, along with supplemental options to fit your needs. We offer a 401(k) plan with employer contributions to help you plan for the future, and we invest in your professional development through training, tuition reimbursement, and educational programs. To help you thrive both at work and at home, we provide flexible scheduling, generous time off, and wellness resources focused on your physical, mental, and emotional health.
