Intake Prior Authorization Jobs in Virginia (NOW HIRING)

Hiring Range

Overview
Supports patient access to specialty medications by coordinating prior authorizations, benefit investigations, and patient assistance programs under the supervision of a licensed pharmacist, while serving as a liaison between patients, providers, payers, and manufacturers to facilitate timely medication approval and therapy initiation. Ensures accurate documentation, clear communication, and compliance with specialty pharmacy accreditation standards and all applicable state and federal regulations while supporting a positive patient experience.
What you will do

• Timely process of referrals and submit clinical supporting documentation to insurance carriers, manufacturers, or foundations to expedite prior authorization and/or patient assistance processes. Collaborate with other departments to assist in obtaining prior authorizations, patient assistance medications or financial assistance. Assist with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed. Follows prior authorization and/or patient assistance workflows and policies/procedures.
• Demonstrates the ability to work independently, meet deadlines and possesses excellent time management skills. Perform tasks accurately and efficiently. Possesses excellent interpersonal, customer service and communication skills (both written and verbal); timely responses to key stakeholders.
• Accurate documentation of all intake referrals and/or prior authorization information in patient medical record or patient assistance tracking software in compliance with policy and procedure/workflow. Completes timely documentation within the required tracking systems and retrieves necessary documentation and maintains up to date knowledge of the pharmaceutical companies' patient assistance programs.
• Proactively tracks and manages patient refills/outreach to ensure timely prescription/infusion service.
• Proactively works on prior authorization and patient assistance enrollments that are due to expire.
• Secure patients' demographic and medical information in compliance with organization HIPAA policies and procedures.
• Assists management with inspections, audits, reports and training to ensure compliance with standards and to provide quality service.

Qualifications
Education

• Program Graduate, Pharmacy Technician Training Program or equivalent (Preferred) or
• Program Graduate, Licensed Practical Nurse (Required) or
• Program Graduate, Certified Medical Assistant (Required)

Experience

• 3-4 years Experience as a Pharmacy Technician, LPN or CMA (in lieu of education) (Required)
• 1 year Experience obtaining and managing medication prior authorization as part of job function (Preferred)
• 1 year Prior Experience obtaining and managing patient assistance program applications (Preferred)

Skills and Abilities

• Familiar with medical and pharmacy terminology
• Prescription drug and over-the-counter knowledge
• Basic math skills, including pharmaceutical calculations
• Basic pharmacy workflow
• Understanding pharmacy computer systems
• Ability to navigate and read electronic health record
• Strong written and verbal communication skills
• Ability to prioritize, problem solve and multitask
• Excellent customer service skills
• Knowledge of patient assistance programs
• Experience with prior authorization of medications
• Strong organizational skills and detail oriented

Licenses and Certifications

• Registered Pharmacy Technician - Virginia Department of Health Professions (VDHP) Upon Hire(Required) and
• Pharmacy Technician Certification Board (PTCB) - Pharmacy Technician Certification Board (PTCB) PTCB or ExCPT Upon Hire(Required) or
• Licensed Practical Nurse (LPN) - Virginia Department of Health Professions (VDHP) Upon Hire(Required) or
• Certified Medical Assistant (CMA) - American Association of Medical Assistants (AAMA) Upon Hire(Required)
• Advanced certification in specialty pharmacy field (PTCB, ASHP, NCODA and other approved programs) (Preferred)

To learn more about being a team member with Riverside Health System visit us at https://www.riversideonline.com/careers.