Manager Prior Authorization Jobs in Alabama (NOW HIRING)

The medication access specialist will be primarily responsible for the following tasks: proactively reviewing and verifying patients' drug benefit information to ensure reimbursement requirements are met, processing test claims for medications, conducting third party prior authorization requests, educating patients on DCH retail pharmacy services, proactively obtaining payment information for patients using the DCH retail pharmacy, identifying opportunities for improving reimbursement from payers, documentation of activities on all applicable software platforms, and obtaining accurate patient medication histories.

This position is also responsible for managing all duties of the medication patient assistance recovery programs for DCH, and is responsible for managing and coordinating all activities associated with Specialty Orders.

The position will work with the hospital and clinic employees on multiple levels, including medical/clinical staff, pharmacists, pharmacy technicians, nurses, social workers, and case management members.

Under the guidance of the pharmacy leadership, this position is responsible for completing the necessary functions to improve patient access to medications by supporting the functions of inpatient and outpatient pharmacists.

• Proactively review and verify patients' drug benefit information within the electronic medical record (EMR) and retail pharmacy computer system
• Review medications prescribed to patients across the DCH Health System, conduct patient insurance and financial reviews facilitate adherence to medications by ensuring that patients receive prescribed medications in a timely manner.
• Maximize revenue capture for high cost take-home medications by completing third party (external) medication authorization.
• Improve patient service experience and DCH outpatient pharmacy revenue through provision of test claims and prior authorization services.
• Market and educate patients and/or families on the existence and value of DCH outpatient pharmacy.
• Assist patients discharging from the hospital to acquire medications, which require meeting and speaking with patients.
• Perform duties as assigned by Pharmacy Manager or other Pharmacist, including utilizing pharmacy systems to enter patient and drug information, ensuring information is entered correctly, filling prescriptions by retrieving, counting and pouring pharmaceutical drugs, verifying medicine is correct, and checking for possible interactions
• Register all related sales on assigned cash register, collect and handle cash as required. Assist in locating products.
• Assist pharmacists in scheduling and maintaining work flow.
• In accordance with state and federal regulations, assist the pharmacist, under direct supervision, in the practice of pharmacy. Assist the pharmacist in the performance of other Pharmacy Department duties in accordance with policies and procedures.
• Provide patients with excellent customer service by being greeting them and offering assistance to have a positive experience.
• Assist and support Pharmacy Department on inventory management activities, such as ordering, unpacking, checking and storing shipment of pharmaceuticals. Maintain knowledge of compliance requirements and process invoices. Notify pharmacist of shortages
• Report, immediately, prescription errors to pharmacist on duty and adhere to company policies and procedures in relation to pharmacy errors and the Quality Improvement Program.

DCH Standards:

• Maintains performance, patient and employee satisfaction and financial standards as outlined in the performance evaluation.
• Performs compliance requirements as outlined in the Employee Handbook
• Must adhere to the DCH Behavioral Standards including creating positive relationships with patients/families, coworkers, colleagues and with self.
• Performs essential job functions in a manner that ensures the safety of patients, visitors and employees.
• Identifies and reduces unsafe practices that may result in harm to patients, visitors and employees.
• Recognizes and takes appropriate action to reduce risks and hazards to promote safety for patients, visitors and employees.
• Requires use of electronic mail, time and attendance software, learning management software and intranet.
• Must adhere to all DCH Health System policies and procedures.
• All other duties as assigned.

Must be registered as a technician in State of Alabama by start date. Must have national certification by PTCB or ExCPT. Must have a minimum of one year experience in medication reimbursement and health care insurance preauthorization. Three years' experience in pharmacy practice is preferred. Experience with patient assistance programs is preferred. Baccalaureate degree is strongly preferred. Must be able to operate computer, calculator, telephone, and other pharmacy related equipment. Prior computer experience using Microsoft Office systems required, Strong communication skills required, Excellent interpersonal skills required, Must be able to work under pressure and meet deadlines, Must be detail oriented with strong follow-up skills, Must have strong telephone presence/etiquette, Must have better than average layman's knowledge of various medications and medication classes.

Working Conditions:

Able to stand, walk, reach, sit, crouch and stoop for extended periods of time. Must be able to carry objects weighing 35 pounds. Requires good motor coordination with good manual and finger dexterity. Must have the ability to communicate with staff and patients of all ages. Physical presence onsite is essential. Hearing and vision must be normal or corrected to within normal range. Able to perform the duties with or without reasonable accommodation.