PHARMACY AUTHORIZATION COORDINATOR
Job Description:
Forcare Medical Group is seeking dedicated, professional and friendly candidates who are looking for a rewarding and stable career.
Job Summary:
Primary duty for the pharmacy coordinator is to investigate and verify benefits for pharmacy for assigned cases; obtain prior authorizations; initiate requests, track progress, and expedite responses from insurance carriers and other payers, and maintain contact with customers to keep them continuously informed. Review for accuracy of prescribed treatment regimen prior to submission of authorization. Facilitate appeals process between the patient, physician and insurance company; Complete status check with insurance company regarding receipt/outcome of prior authorization and appeal; obtain approval information and activates copay cards based off of eligibility and specific drug prescribed. Track, report and escalate service issues arising from requests for authorizations, financial assistance or other issues that delay service. Notify patients when their prescription has been transferred and follow up with specialty pharmacy to confirm the prescription was received. Coordinate verbal transfer by a pharmacist if specialty pharmacy has no record of prescription; confirm with patient that prescription was received from alternate specialty pharmacy. Complete a series of assessments mandated by either manufacturer contracts or operations and facilitates patient enrollment with manufacturer. When required Document case activity, communications and correspondence in computer system to ensure completeness and accuracy of patient contact records.
Specific Duties and Responsibilities:
- Under the general supervision of the department manager, the Medication Authorization Coordinator will do the following:
- Coordinate all aspects of medication ordering, authorizations, patient assistant enrollment, and appeals
- Order medications for patients under provider direction including PCP, Dermatology, Rheumatology with large portion of biologics and infusions.
- Initiate prior authorization for medications with insurance and close follow-up with third party specialty pharmacies to ensure medication receipt to patient.
- Update patients with prior authorization outcomes (approvals/denials). Resolve medical issues with patients and pharmacies.
- Responsible for accurate and timely data entry in accordance with workflow requirements
- Record and monitor reconciliation log for quality assurance purposes.
- Counsel patients regarding medications, specialty pharmacies and pharmacy benefits.
- Assist physicians as chaperones including: Clean exam rooms and escort patients to rooms. • Enter patient information into eCW system, provide injection training
- Medication Sample Management
- Assist in other secretarial functions as needed under the direction of the Department Manager.
- Conforms to all applicable HIPAA, billing compliance, and safety guidelines.
- Related duties as assigned.
