Pharmacy Tech III - Prior Auth

Summary

NKC Health is hiring a Pharmacy Tech III (Prior Auth) to join our Headache Center team in the Northland! If you’re looking for a great opportunity to serve our community and be part of a growing organization, join our NKC Health team!

Here at NKC Health our mission is to provide hope and healing to every life we touch. Whether you are serving patients at a primary care practice, specialty practice, or in a support capacity, every team member works together to complete this mission. Joining NKC Health means you are joining a family that is committed to serving our community and giving patients better quality of life.

• Comprehensive Benefits (Medical, Dental, Vision, Life, FSA)
• Competitive wages
• Paid time off for personal/vacation/sick
• Six paid holidays per year
• Educational assistance
• Day shift schedules

As an integral member of the pharmacy team and under the supervision of a pharmacist, the prior authorization pharmacy technician is responsible for providing clinic‑based prior authorization support and improving patient care fragmentation, so patient scan obtain their medication timely. These efforts lead to increased patient adherence and satisfaction which subsequently result in an improved quality of life as well as patient outcomes.

The position allows for a workload shift to an appropriate skill mix improving provider, nursing, and office staff satisfaction as more time is available for direct patient care related activities. The individual will also perform all required technical functions within the pharmacy department to assist in providing quality pharmaceutical care to patients as needed. The prior authorization technician may provide services within the scope of their license, certification, registration, and/or assessed competencies.

Practice will be in accordance with laws and regulations.

• Conduct patient scheduling process by receiving referrals, screening patient demographic information, conducting benefits investigation, and determining payer coverage. Documents formal notes in the electronic medical record where appropriate, documenting the findings of the prior authorizations.
• Provide specialized information on a variety of matters relating to the processing of prior authorizations. Contact payers and obtain prior authorizations that meet payer criteria for access. As necessary, outline how long it will take to review and approve/deny the priorauthorization. Ensure insurance coverage requests are submitted along with all necessary documentation. Prospectively complete re‑authorization of expiring prior authorizations for patients that will be continuing therapy.
• Validate benefit information before a patient arrives for an appointment and verify details thoroughly to ensure a comprehensive claims process that helps prevent revenue loss and enhances fiscal stability.
• Coordinate the processing, distribution, and delivery of referrals while maintaining product integrity, managing inventory of specialty medications, following up with patients to ensure that they receive medications, and billing for services rendered.
• Identify co‑pay assistance for medications including manufacturer co‑pay cards or foundation assistance. Act as a liaison for manufacturer provided medication assistance programs for healthcare staff and patients. Identifies all qualified medication assistance program participants in accordance with eligibility requirements.
• Other duties as assigned.
• Practice will be in accordance with laws and regulations.

• Required:
  
  Minimum three (3) years of experience in healthcare or related field.
• Preferred:
  Two (2) years of experience working with managed care insurance companies and/or Medicare/Medicaid.
• T…