Amber Specialty Pharmacy
Dedicated Authorization Management Specialist
Amber Specialty Pharmacy, Omaha, Nebraska, us, 68197
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.
Location: In Office (Omaha)
Hours: 8a-5p CST
Workdays: Monday - Friday
Weekends: No
Wages based on experience
Must be a Pharmacy Technician
Amber Specialty Pharmacy
Job Title:
Dedicated Authorization Management Specialist
Department:
Operations
FLSA:
Non-Exempt
General Functions:
Responsible for preparing prior authorizations and appeals, correspondence with prescriber's offices, and documenting information in the electronic medical record for an assigned product program. Gathers pertinent patient history and information, evaluates, responds, and completes appeals and prior authorizations accurately and timely. Provides exceptional customer service in all interactions.
Reporting Relations
Reports to:
Program Management Lead
Direct Reports : None
Primary Duties and Responsibilities:
Initiates and completes prior authorizations and appeals for specialty pharmacy for all patients of an assigned product program.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, Pharma partners, and patients to obtain 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.Collaborates with program team members on other aspects of the product program, not limited to intake and patient access functions and patient communications and onboarding.Advocates on the patient's behalf to identify and assess coverage issues.Assists licensed professionals 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.This is an office-based position.Professional Competencies:
Proficient with MS Excel, Word, and OutlookUnderstanding of insurance verification and online prescription adjudicationStrong oral, written, and interpersonal skillsSelf-initiativeDemonstrated ability to meet tight deadlinesAbility to work with all levels of internal management and staff, as well as outside clients and vendorsWorking knowledge of Medicare, Medicaid, Commercial Insurance and renal programs related to pharmacy, billing, grants, copay cards, prior authorizations, and rejectionsPrior PAP, PA, and copay card experience preferredPrior experience troubleshooting rejected pharmacy claims preferredProficiently read and understand abstract information from handwritten patient medical recordsEducational and Experience Requirements:
High school diploma or equivalentWorking knowledge of the healthcare industryHIPPA trained and/or the ability to work with and protect highly confidential patient and employee informationSix months or less of similar or related work experienceLicensure and Certification Requirement:
Nationally Certified Pharmacy Technicians Preferred
Physical Requirements:
Must be able to remain in a stationary position -up to 90% of the timeThe person in this position needs to occasionally move about inside the office to access file cabinets, office machinery, etc., and traverse conferences, meetings, and remote eventsConstantly operates a computer and other office productivity machinery, such as a calculator, copy machine, and computer printerThe ability to communicate information and ideas so others will understand. Must be able to exchange accurate information in these situationsThe 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, vendors, insurance carriers, government entities, such as Medicare/Medicaid, and customers.
Confidentiality:
The position Interactions with medical personnel and patients and access proprietary and medical (HIPAA) information in various interactions and matters.
Apply now and join our mission to provide exceptional patient care!
Location: In Office (Omaha)
Hours: 8a-5p CST
Workdays: Monday - Friday
Weekends: No
Wages based on experience
Must be a Pharmacy Technician
Amber Specialty Pharmacy
Job Title:
Dedicated Authorization Management Specialist
Department:
Operations
FLSA:
Non-Exempt
General Functions:
Responsible for preparing prior authorizations and appeals, correspondence with prescriber's offices, and documenting information in the electronic medical record for an assigned product program. Gathers pertinent patient history and information, evaluates, responds, and completes appeals and prior authorizations accurately and timely. Provides exceptional customer service in all interactions.
Reporting Relations
Reports to:
Program Management Lead
Direct Reports : None
Primary Duties and Responsibilities:
Initiates and completes prior authorizations and appeals for specialty pharmacy for all patients of an assigned product program.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, Pharma partners, and patients to obtain 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.Collaborates with program team members on other aspects of the product program, not limited to intake and patient access functions and patient communications and onboarding.Advocates on the patient's behalf to identify and assess coverage issues.Assists licensed professionals 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.This is an office-based position.Professional Competencies:
Proficient with MS Excel, Word, and OutlookUnderstanding of insurance verification and online prescription adjudicationStrong oral, written, and interpersonal skillsSelf-initiativeDemonstrated ability to meet tight deadlinesAbility to work with all levels of internal management and staff, as well as outside clients and vendorsWorking knowledge of Medicare, Medicaid, Commercial Insurance and renal programs related to pharmacy, billing, grants, copay cards, prior authorizations, and rejectionsPrior PAP, PA, and copay card experience preferredPrior experience troubleshooting rejected pharmacy claims preferredProficiently read and understand abstract information from handwritten patient medical recordsEducational and Experience Requirements:
High school diploma or equivalentWorking knowledge of the healthcare industryHIPPA trained and/or the ability to work with and protect highly confidential patient and employee informationSix months or less of similar or related work experienceLicensure and Certification Requirement:
Nationally Certified Pharmacy Technicians Preferred
Physical Requirements:
Must be able to remain in a stationary position -up to 90% of the timeThe person in this position needs to occasionally move about inside the office to access file cabinets, office machinery, etc., and traverse conferences, meetings, and remote eventsConstantly operates a computer and other office productivity machinery, such as a calculator, copy machine, and computer printerThe ability to communicate information and ideas so others will understand. Must be able to exchange accurate information in these situationsThe 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, vendors, insurance carriers, government entities, such as Medicare/Medicaid, and customers.
Confidentiality:
The position Interactions with medical personnel and patients and access proprietary and medical (HIPAA) information in various interactions and matters.
Apply now and join our mission to provide exceptional patient care!