Job Description:
• Manage and process prior authorization requests for specialty medications
• Communicate with provider offices, patients, payers, and specialty pharmacies to obtain clinical documentation and authorization approvals
• Submit, monitor, and track prior authorization requests through payer portals, fax, phone, and electronic systems
• Follow up on pending prior authorizations, appeals, renewals, and denials to ensure timely patient access
• Verify patient insurance coverage, benefits, and specialty pharmacy requirements
• Input necessary data into the pharmacy management system and maintain up-to-date project information
• Receive, analyze, gather, and organize data from multiple sources
• Accurately enter required data into databases, documents, or spreadsheets
• Collaborate with pharmacy operations, sales, and data teams
• Support existing data projects
• Use the pharmacy system to obtain patient and drug information and process prescriptions
• Manage prescription refills for integrated offices
• Apply manufacturer copay cards when applicable
• Adhere to company policies, confidentiality standards, information security policies, and privacy requirements
• Participate in continuous quality improvement activities
Requirements:
• Pharmacy Technician Experience
• Experience with specialty medications and prior authorization processes preferred
• Knowledge of commercial, Medicare, and Medicaid insurance plans
• Familiarity with specialty pharmacy workflows and reimbursement procedures
• Familiarity with the prescription adjudication process
• Ability to learn pharmacy management systems to extrapolate pertinent data
• Ability to communicate effectively within various levels of the organization
• Ability to read, comprehend, and write correspondence
• Ability to present information effectively in one-on-one and small group situations
• Ability to comprehend and apply principles of basic math
• Ability to apply common sense understanding
• Strong analytical and problem-solving skills
• Excellent interpersonal, negotiation, and conflict resolution skills
• Proficiency in Word and Excel or related software
• Comfortable using RingCentral and experience with patient outreach
• Experience using payer portals such as CoverMyMeds or similar authorization platforms preferred
• Compliance with Apotheco information security policies, employee handbook, and security and privacy regulatory requirements
• Time management, oral and written communication, professionalism, organization, customer service, prioritization, attention to detail, multitasking, goal orientation, dependability, confidentiality, and self-motivation
• Ability to work well with various departments and within a team
Benefits:
• Remote, home-based position
• Reliable internet access and private workspace for confidential patient interactions
• Reasonable accommodation may be made for individuals with disabilities
• Continuous quality improvement activities