Medication Prior Authorization Technician
Company: Memorial Health
Posted on: October 13, 2021
Reviews all scheduled inpatient and outpatient procedures and
outpatient diagnostic services to validate the scheduled procedure
or diagnostic service has the appropriate payor authorization or
meets the payor's medical policies, there is a valid physician
order, and other clinical documentation requirements are met prior
to the scheduled procedure or diagnostic service. Completes all
medication prior authorization request.
To perform this job successfully, an individual must be able to
perform each essential duty satisfactorily. The requirements listed
below are representative of the knowledge, skill, and/or ability
- Must possess good communication and interpersonal relationship
- Must be able to organize work with minimal supervision.
- Must be able to focus attention to minute details.
- Above average computer skills including Word, Excel and
software applications required.
Education and/or Other Requirements
Illinois Pharmacy Tech Certification required.
- Understands and applies payor prior-authorization requirements,
and stays current with payor changes.
- Interacts effectively with physicians and/or office staff when
receiving information regarding hospital outpatient diagnostic
services/ prior auth of medications
- Provides information and assistance for Utilization Review and
Patient Financial Services.
- Primary function is to receive and coordinate
pre-authorizations/RQI's on patient accounts for all outpatient
services and schedule inpatient admissions and medications
- Coordinates phone calls in a positive and professional manner
to meet departmental goals.
- Prioritizes medication requests in accordance with managed care
pre-auth requirements and medical necessity requirements.
- Utilizes the account note function to record all telephone
conversations, consultations, pertinent case specific information,
and rationale for decision on cases, all reference numbers and
- Provides excellent customer service by adhering to quality
standards and case management/confidentiality policy and
- Communicates daily with appropriate parties for prior approval
on patient accounts (case management or nurses at doctor's
- Maintains/documents accurate record of insurance/pre-auth
- Communicates barriers or process improvement opportunities to
- Assists in training new personnel or in implementing new
- Performs other duties as assigned.
Keywords: Memorial Health, Decatur , Medication Prior Authorization Technician, Other , Decatur, Illinois
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