Prior Authorization Coordinator - Pharmacy Technician 1
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.