Prior Authorization Coordinator - Pharmacy Technician 1

Job description

• Determine patient eligibility and benefits for specific medications by contacting insurance providers.
• Collect required demographic, clinical, and insurance details from patients, physicians, and clinical staff to support authorization requests.
• Initiate, submit, and track prior authorization requests through various portals and systems, ensuring timely processing by the insurance company.
• Act as a liaison between patients, referring physicians, clinical staff, and insurance companies to communicate status updates, resolve discrepancies, and provide requested information.
• Follow up on denied claims, gather additional documentation, and coordinate with the clinical team to file appeals and secure approvals.
• Maintain clear and accurate logs of all authorization attempts, communications, decisions, and approvals in patient records and organizational databases.
• Adhere to strict HIPAA regulations and company policies to protect patient information and ensure the privacy and security of all data.
• High School Diploma,
• Active State of Oregon Pharmacy Technician License, including the completion and maintenance of job-specific competencies and certifications.

Job Related Knowledge, Skills and Abilities (Competencies):
• Must possess computer keyboarding skills.
• Excellent interpersonal communication
• Knowledge base of insurance reimbursement.
• Knowledge of managed care environment.
• Successfully completes initial and continued competencies as required for maintenance of standard of practice, legal regulatory compliance, and OHSU policies.
• Formal pharmacy technician training program
• Oregon Board of Pharmacy Certified Technician license
• Inpatient and outpatient hospital pharmacy experience.
• Medical and scientific nomenclature.