Shire Jobs

Job Overview: The prior authorization specialist is responsible for coordinating all aspects of the prior authorization process, including insurance verification, formulary reviews, gathering necessary clinical information from electronic medical record, and timely communication with patients, prescribers and physician office staff. Candidates should possess knowledge of third party reimbursement regulations and medical terminology as well as seek out assistance from a pharmacist or physician as necessary. Success in this role will require strong communication, interpersonal, and problem solving skills. This person should be able to interact and communicate effectively with internal and external customers, physician office staff, and all members of the organization. Essential Functions * Research and investigate Prior Authorization (PA) requirements by insurance company * Obtain Prior Authorization status updates from the insurance company and communicate to patient, pharmacy, or physician's office as necessary * Submit Prior Authorization application forms and all required supporting documentation to the insurance company * Review medical record to obtain necessary patient demographic and clinical information and seek timely clarification from pharmacist or physician as necessary * Review Prior Authorization denials and communicate reasons for denial to physicians and patients * Serve as a subject matter expert for drug formularies and the prior authorization process in general * Follows up with insurance companies in a timely manner regarding Prior Authorizations * Provides excellent customer service as evidenced by a willingness and ability to assist customers (both internal and external) with their questions/concerns, treating customers in a friendly and helpful manner, and maintaining a positive attitude Job Requirements: High School Degree or GED in Pharmacy; Pharmacy Technician or Medical Assistant Certified Pharmacy Technician or Certified Medical Assistant desired Prior experience with medication Epic and/or prior authorizations desirable 2-3 years experience Clinical Pharmacy Pharmacy Technician or Medical Assistant Job Responsibilities: Other job-related information: Working Conditions: Climbing - Rarely Concentrating - Frequently Continous Learning - Consistently Hearing: Conversation - Consistently Interpersonal Communication - Consistently Kneeling - Rarely Lifting TriHealth is an equal opportunity employer. We are committed to fostering a diverse and inclusive workforce.