Pharmacy Technician Prior Authorization - Intermountain Health
Boston, MA
About the Job
Job Description:
Processes medication electronic prior authorization (ePA) requests on behalf of clinics and
providers, allowing patients access to insurance coverage for their medications. Answers
incoming phone calls from patients to the SCL Health Outpatient Pharmacies in Colorado and
Montana. Troubleshoots coverage issues and communicates ePA results to patients, providers,
and other stakeholders.
This is a full remote position. Applicants need to live in Colorado or Montana. The hours will be normal clinic hours, M-F, no holidays.
1. Evaluates and processes submission of electronic prior authorization medications requests from a variety of stakeholders (external pharmacies, patients, and clinics and providers). Researches, resolves and documents prior authorization outcomes in the pharmacy system. Communicates selected prior authorization criteria, pharmacy benefit coverage and formulary alternatives to physicians, physician's office staff, medical management staff and/or pharmacists. Escalates requests to Pharmacists when request requires extensive clinical review or denial. Researches, resolves and documents physician or client inquiries and grievances and provides verbal or written results to client, prescriber, provider and/or management.
2. Completes assigned ePA tasks each day and communicates issues and workflow problems to pharmacy leadership to facilitate quick resolution.
3. Works as a member of the Pharmacy Call Center team and fosters a collaborative team oriented work environment.
4. Participates and leads improvement initiatives and implementation of new processes and procedures. Coordinates orientation and training of new associates. Ensures compliance with applicable regulatory guidelines and established departmental policies and procedures, objectives, quality assurance program, safety, environmental and infection control standards.
5. Participates in problem solving to address issues relating to patient safety, care and service. Supports and promotes effective working relations and works effectively as part of a department/unit team and interdepartmentally to facilitate that department’s ability to meet its goals and objective. Collaborates with the department leadership team to coordinate care with all branches and promote the highest level of patient care and team satisfaction.
6. Completes documentation according to departmental standards in a timely fashion.
7. Answers incoming calls for all Outpatient Pharmacies. Maintains the highest level of customer service for all patients, customers, and associates. Efficiently manages phone call intake, PAs, and problem resolution to aid in the seamless workflow at each pharmacy. Works with patients to assist in enrollment with copay assistance programs offered by manufacturers. Engages problem solving skills in an autonomous manner to facilitate timely resolutions. Provides information to associates regarding available pharmacy benefits and services including: mail order, specialty pharmacy, and other pharmacy programs and initiatives. Knowledgeable in all Intermountain benefits programs and offerings for each year.
8. Accurately types, bills and prepares prescriptions to extent allowed by state and federal rules and regulations. Routes questionable prescriptions to the pharmacist for completion. Performs basic calculations to determine doses and correct day supplies to be billed to 3rd party insurance companies. Performs necessary calculations to accurately prepare a compounded prescription, in support of outpatient pharmacy operations.
9. Communicates effectively as a member of the Outpatient Pharmacy team in a remote capacity, supporting effective and efficient processing of patient prescriptions.
10. Participates in quality and patient safety initiatives. Identifies potential areas for improvement including processes that could be streamlined or revised to improve satisfaction for all end users. Identifies potential safety hazards that may create problems for patients and/or staff, and takes appropriate actions. Participates in departmental meetings, contributing ideas or feedback.
11. Promotes mission, vision, and values of Intermountain Health, and abides by service behavior standards. 12. Performs other duties as assigned.
13. (If applicable) May be required to be placed on-call during a regularly scheduled shift.
Minimum Requirements:
+ High School or equivalent is required.
+ Licensed or eligible to be licensed as a Pharmacy Technician in Colorado (within 90 days of hire). Licensed or eligible to be licensed as a Pharmacy Technician in Montana (within 90 days of hire).
+ Pharmacy Technician Certification
Preferred Requirements:
+ Technician training is preferred.
+ Two (2) years Technician experience – hospital or retail
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements list must be representative of the knowledge, skills, minimum education, training, licensure, experience, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
+ Positive problem solving attitude.
+ Great customer service and team player.
+ Work schedule- currently days with potential for weekends as volume demands increase
+ Regular attendance to perform work on site during regularly scheduled business hours or scheduled shifts is required
+ Ability to communicate effectively and diplomatically within a multi-functional team
+ Strong organizational skills and attention to detail
+ Ability to successfully function in a fast paced, service oriented environment
+ Competent in understanding and usage of computers and software programs, including the Microsoft Office Suite and Google. Ability to learn new applications relevant to the position.
Physical Requirements:
Carrying, Climbing, Crawling, Hearing/Listening, Lifting, Manual Dexterity, Pulling/Pushing, Seeing, Speaking, Squatting/Kneeling, Standing, Walking
Location:
Saint Joseph Hospital
Work City:
Denver
Work State:
Colorado
Scheduled Weekly Hours:
40
The hourly range for this position is listed below. Actual hourly rate dependent upon experience.
$18.29 - $27.32
We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.
Learn more about our comprehensive benefits packages for our Idaho, Nevada, and Utah based caregivers (https://intermountainhealthcare.org/careers/working-for-intermountain/employee-benefits/) , and for our Colorado, Montana, and Kansas based caregivers (http://www.sclhealthbenefits.org) ; and our commitment to diversity, equity, and inclusion (https://intermountainhealthcare.org/careers/working-for-intermountain/diversity/) .
Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.
All positions subject to close without notice.
Processes medication electronic prior authorization (ePA) requests on behalf of clinics and
providers, allowing patients access to insurance coverage for their medications. Answers
incoming phone calls from patients to the SCL Health Outpatient Pharmacies in Colorado and
Montana. Troubleshoots coverage issues and communicates ePA results to patients, providers,
and other stakeholders.
This is a full remote position. Applicants need to live in Colorado or Montana. The hours will be normal clinic hours, M-F, no holidays.
1. Evaluates and processes submission of electronic prior authorization medications requests from a variety of stakeholders (external pharmacies, patients, and clinics and providers). Researches, resolves and documents prior authorization outcomes in the pharmacy system. Communicates selected prior authorization criteria, pharmacy benefit coverage and formulary alternatives to physicians, physician's office staff, medical management staff and/or pharmacists. Escalates requests to Pharmacists when request requires extensive clinical review or denial. Researches, resolves and documents physician or client inquiries and grievances and provides verbal or written results to client, prescriber, provider and/or management.
2. Completes assigned ePA tasks each day and communicates issues and workflow problems to pharmacy leadership to facilitate quick resolution.
3. Works as a member of the Pharmacy Call Center team and fosters a collaborative team oriented work environment.
4. Participates and leads improvement initiatives and implementation of new processes and procedures. Coordinates orientation and training of new associates. Ensures compliance with applicable regulatory guidelines and established departmental policies and procedures, objectives, quality assurance program, safety, environmental and infection control standards.
5. Participates in problem solving to address issues relating to patient safety, care and service. Supports and promotes effective working relations and works effectively as part of a department/unit team and interdepartmentally to facilitate that department’s ability to meet its goals and objective. Collaborates with the department leadership team to coordinate care with all branches and promote the highest level of patient care and team satisfaction.
6. Completes documentation according to departmental standards in a timely fashion.
7. Answers incoming calls for all Outpatient Pharmacies. Maintains the highest level of customer service for all patients, customers, and associates. Efficiently manages phone call intake, PAs, and problem resolution to aid in the seamless workflow at each pharmacy. Works with patients to assist in enrollment with copay assistance programs offered by manufacturers. Engages problem solving skills in an autonomous manner to facilitate timely resolutions. Provides information to associates regarding available pharmacy benefits and services including: mail order, specialty pharmacy, and other pharmacy programs and initiatives. Knowledgeable in all Intermountain benefits programs and offerings for each year.
8. Accurately types, bills and prepares prescriptions to extent allowed by state and federal rules and regulations. Routes questionable prescriptions to the pharmacist for completion. Performs basic calculations to determine doses and correct day supplies to be billed to 3rd party insurance companies. Performs necessary calculations to accurately prepare a compounded prescription, in support of outpatient pharmacy operations.
9. Communicates effectively as a member of the Outpatient Pharmacy team in a remote capacity, supporting effective and efficient processing of patient prescriptions.
10. Participates in quality and patient safety initiatives. Identifies potential areas for improvement including processes that could be streamlined or revised to improve satisfaction for all end users. Identifies potential safety hazards that may create problems for patients and/or staff, and takes appropriate actions. Participates in departmental meetings, contributing ideas or feedback.
11. Promotes mission, vision, and values of Intermountain Health, and abides by service behavior standards. 12. Performs other duties as assigned.
13. (If applicable) May be required to be placed on-call during a regularly scheduled shift.
Minimum Requirements:
+ High School or equivalent is required.
+ Licensed or eligible to be licensed as a Pharmacy Technician in Colorado (within 90 days of hire). Licensed or eligible to be licensed as a Pharmacy Technician in Montana (within 90 days of hire).
+ Pharmacy Technician Certification
Preferred Requirements:
+ Technician training is preferred.
+ Two (2) years Technician experience – hospital or retail
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements list must be representative of the knowledge, skills, minimum education, training, licensure, experience, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
+ Positive problem solving attitude.
+ Great customer service and team player.
+ Work schedule- currently days with potential for weekends as volume demands increase
+ Regular attendance to perform work on site during regularly scheduled business hours or scheduled shifts is required
+ Ability to communicate effectively and diplomatically within a multi-functional team
+ Strong organizational skills and attention to detail
+ Ability to successfully function in a fast paced, service oriented environment
+ Competent in understanding and usage of computers and software programs, including the Microsoft Office Suite and Google. Ability to learn new applications relevant to the position.
Physical Requirements:
Carrying, Climbing, Crawling, Hearing/Listening, Lifting, Manual Dexterity, Pulling/Pushing, Seeing, Speaking, Squatting/Kneeling, Standing, Walking
Location:
Saint Joseph Hospital
Work City:
Denver
Work State:
Colorado
Scheduled Weekly Hours:
40
The hourly range for this position is listed below. Actual hourly rate dependent upon experience.
$18.29 - $27.32
We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.
Learn more about our comprehensive benefits packages for our Idaho, Nevada, and Utah based caregivers (https://intermountainhealthcare.org/careers/working-for-intermountain/employee-benefits/) , and for our Colorado, Montana, and Kansas based caregivers (http://www.sclhealthbenefits.org) ; and our commitment to diversity, equity, and inclusion (https://intermountainhealthcare.org/careers/working-for-intermountain/diversity/) .
Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.
All positions subject to close without notice.
Source : Intermountain Health