3867 - Medication Access Coordinator

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Department:
Pharmacy

The Prior Authorization Pharmacy Technician works under the direct supervision of a licensed pharmacist.

This position supports the pharmacy team by efficiently managing the prior authorization process and assisting with the procurement of prescription medications and durable medical equipment The Prior Authorization Pharmacy Technician will be responsible for verifying patient insurance eligibility and coverage, processing third party payer authorization for medications and DMEs, assisting with calls from pharmacies, physicians, and other medical professionals in support of prior authorization for medication and DME approvals, and providing patient assistance support.

1.

Review prescription orders for medications and DME and identify those requiring prior authorization or copay assistance.
2.

Verify and complete accurate and timely insurance verification.
3.

Completes accurate and timely third-party payer prior authorization requests, including but not limited to ensuring the necessary information needed for an authorization (e.g.

demographic information, clinical notes, CPT codes, diagnosis codes), via electronic portals, fax, or phone.
4.

Communicate with patients, insurers, and other healthcare professionals to obtain additional clinical information regarding non-covered benefits or coverage issues to support prior authorization approvals.
5.

Coordinate with insurance representative to process claims and provide accurate co-pay information for patients.
6.

Communicate with program administrators for reimbursement assistance programs sponsored by the drug manufacturer.
7.

Research and apply manufacturer coupons and financial patient assistance programs to assist with medication procurement when available.
8.

Provide referrals, medical necessity, and clinical supporting documentation to third-party insurances to expedite approval for prior authorizations and ensure that appropriate follow-up is performed.
9.

Review denials and submit appeals, if requested by physician, to facilitate approval from thirdpartyinsurance companies.
10.

Proactively identify and process prior authorizations nearing expiration to ensure continued patient access.
11.

Follow up on pending prior authorization requests to expedite approval and avoid delays in patient medication access.
12.

Document all prior authorization information including approval dates, prior authorization number, and determination status in patient profile.
13.

Document all prior authorization and patient assistance activities accurately in the electronic medical record system and third-party software (e.g., TherigySTM, PioneerRx, and Epic).
14.

Notify pharmacists, providers, and patients regarding the status of prior authorization requests.
15.

Maintain up-to-date knowledge of insurance formularies, prior authorization cr...