Prior Authorization Coordinator

Apply now Job no: 64206
Department: Pharmacy-Retail
Employer: State of New York
Payroll Title: TH Staff Assistant 1, NSSL2
Bargaining Unit: UUP (State University Professional Services Unit)
Salary: Commensurate with Qualifications
Work type: Full-time
Location: Syracuse
Categories: Allied Health

Job Summary: Review and evaluate outpatient take-home medications to assure the appropriateness and medical necessity of medication use based on established criteria. Obtain prior authorization from intermediaries and payers, including managed care companies, insurance companies, and review organizations. Ensure completion of activities that maximize revenue capture for high-cost medications.

Conduct prospective prior authorization services to expedite clinic workflow and enhance patient care by preventing therapy interruptions due to insurance paperwork issues.

Improve patient service experience and Upstate Medical University Hospital retail pharmacy revenue through provision of prior authorization services at Upstate Medical University Hospital clinics.

Observe and understand prescribing trends within Upstate University Hospital clinics to identify areas for improved specialty pharmacy contracting.

Develop an effective working relationship with external entities.

Refer appropriate patients to the Medication Assistance Program (MAP). Identify self-pay patients eligible for enrollment into the MAP and coordinate enrollment with the MAP staff.  
Minimum Qualifications:

Associate's Degree in a science or health related field and three years of pharmacy technician experience in a pharmacy and National Pharmacy Technician Certification; OR NYS Licensed LPN with three years of post licensure experience to include medical billing office experience required; OR at least 5 years of experience in a similar prior authorization role. Excellent written/oral communication, interpersonal, organizational, conflict resolution, and computer skills required.

Preferred Qualifications:

Experience with medication reimbursement, medications, physician orders and insurance claim submission preferred. Experience with healthcare insurance prior authorization/coding and performing insurance carrier/managed care review preferred.  

Work Days:

Monday - Friday, Days

Message to Applicants:  
Recruitment  Office: Human Resources Department
Executive Order: Pursuant to Executive Order 161, no State entity, as defined by the Executive Order, is permitted to ask, or mandate, in any form, that an applicant for employment provide his or her current compensation, or any prior compensation history, until such time as the applicant is extended a conditional offer of employment with compensation. If such information has been requested from you before such time, please contact the Governor's Office of Employee Relations at (518) 474-6988 or via email at info@goer.ny.gov.              

 

We are an Equal Opportunity Employer.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran status or disability or other protected classes under State and Federal law.

Advertised: Eastern Daylight Time
Applications close:

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