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Medication Prior Authorization Technician

Company: Memorial Health
Location: Decatur
Posted on: October 13, 2021

Job Description:

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 required.

  • Must possess good communication and interpersonal relationship skills.
  • 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 authorization information.
    • Provides excellent customer service by adhering to quality standards and case management/confidentiality policy and procedures.
    • Communicates daily with appropriate parties for prior approval on patient accounts (case management or nurses at doctor's offices).
    • Maintains/documents accurate record of insurance/pre-auth company information.
  • Communicates barriers or process improvement opportunities to management.

  • Assists in training new personnel or in implementing new procedures.

  • Performs other duties as assigned.

Keywords: Memorial Health, Decatur , Medication Prior Authorization Technician, Other , Decatur, Illinois

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