Pharmacy Patient Advocate

Job Responsibilities

• Supports the Pharmacy Department in processing pharmacy prior authorization (PA) requests in an accurate and timely manner
• Performs clinical decision making using approved guidelines while addressing issues pertaining to pharmacy
• Processes and finalizes PA requests based on approved guidelines under the supervision of a pharmacist and/or medical director
• Assures that pharmacy claims are adjudicating correctly
• Communicates clearly and accurately with other healthcare professionals
• Provides reporting for internal and external customers including pharmacy claims analysis
• Participates in the daily review of the Medicare denied claims report
• Meets established departmental performance metrics for quality and productivity

• Requires pharmacy technician licensure in the state of practice (where applicable)
• Pharmacy technician certification required
• 3 or more years of experience performing pharmacy technician duties in a pharmacy setting with managed care emphasis preferably within a healthcare organization or retail pharmacy
• Good written and verbal communication skills for interfacing with all levels of staff, physicians, patients and other contacts
• Ability to learn and master various software programs necessary for job functions

Demonstrates expertise in processing pharmacy prior authorization requests and clinical decision‑making in accordance with approved guidelines. Proficient in pharmacy claims analysis and effective communication with healthcare professionals.

• Processing Pharmacy Prior Authorization Requests
• Finalizing PA Requests
• Adjudicating Pharmacy Claims
• Reporting for Internal and External Customers
• Daily Review of Medicare Denied Claims

• Good Written Communication Skills
• Good Verbal Communication Skills

• Pharmacy Technician Certification

• Healthcare Organization
• Retail Pharmacy
• Managed Care

• Various Software Programs