Job Description
Primary Function: - Assists with prior authorizations, appeals and denials.
- Update and find current and accurate patient insurance information
- Updates authorizations and claims to reflect the new insurance package
- Sorts daily work queues and reports to identify and process the daily work
- Maintain knowledge in generally accepted insurance benefit terms and processes
- Effectively communications as part of the care team (Case and authorization notation - Physician and Practice location staff - Peers - Supervisor/Manager - Payers)
- Requests and prepares supporting documentation such as medical records, dictation, labs, previous prior authorization(s), appeals, denials, and prescriptions
- Investigates authorization denials and appeals (Insurance - Patient)
- Obtains and reviews clinical notes provided by physicians to assist in filling out prior authorization forms (transcribe verbatim). Submits completed prior authorization via ePA or other methods as necessary
- Initiate and obtain appeal required documentation from physicians
- Routinely follow up with physicians and insurance companies on the status of the prior authorization, appeal, or denial.
- Appropriately moves aspns status to reflect the status of the patients aspn
Rotating shifts during the weekdays between the hours of 8:30 AM to 8:00 PM EST (overtime and occasional weekends as per business requirements).
Job Scope and Major Responsibilities: - Identifies all appointments and procedures for assigned departments that require authorization by monitoring the schedules, system reports, and dashboards
- Identifies the referral and authorization requirements of the patients' insurance plans by using various on-line resources according to department workflows
- Demonstrates knowledge of insurance carrier guidelines, clinical policies, and state guidelines pertaining to referrals and prior authorization
- Verifies insurance eligibility and benefits, and updates the patient's insurance information as necessary
- Completes referrals and prior authorizations in a timely manner according to department guidelines and workflows
- Communicates clearly and effectively with patients, physicians, office staff and manager to resolve issues that may result in a denied or delayed authorization request
- Demonstrates complete system knowledge, ability to run reports, document and manage referrals and authorizations, move correspondence, resolve eligibility and authorization holds, and other system tasks within the user's security access
- Demonstrates the ability to request, prepare, and recognize the documentation required to support the medical necessity for the service being authorized
- Provides the supervisor and manager with immediate feedback on issues affecting workflow, reimbursement, and customer service
- Ensures that appropriate and accurate information is entered in the patient account
- Responds timely and collaborates effectively with the ancillary teams to limit denials and ensure proper reimbursement
- Collaborates with team members to meet department deadlines and benchmarks
- Demonstrates the ability to use the electronic tools and systems available to organize and process the daily work
- Anticipates and performs necessary job duties
- Maintains patient confidentiality
- Maintains professional demeanor and courteous attitude
- Compliance with the provisions of the Health Insurance Portability and Accountability Act of 1996 and its implementing regulations, as amended ("HIPAA")
Required Qualifications: New Jersey Office ONLY: - Certified Pharmacy Technician (must be registered with the State of New Jersey Board of Pharmacy as a Pharmacy Technician)
Arizona Office ONLY: - Pharmacy Technician License (requires national certification by PTCB or ExCPT), or Technician Trainee License, issued by the Arizona State Board of Pharmacy.
ALL LOCATIONS: - Minimum of 2 years pharmacy experience preferred
- Previous work experience in a prior authorization role
- General knowledge of pharmacy laws, practices, and procedures
- General knowledge of what a valid prescription requires
- Knowledge of common medical terms/abbreviations and pharmacy calculations
- Understanding of insurance and third-party billing systems
- Skill to prioritize and work in a fast-paced environment
- Exemplary communication, organization, and time management skills
- Capability of working independently and as a member of a team
- Ability to preserve confidentiality of protected health information (PHI)
- Proficient in MS Word, Excel, and Outlook
- Possess and maintain professional demeanor and courteous attitude
- Experience with standard office equipment (phone, fax, copy machine, scanner, email/voice mail) preferred
- Ability to preserve confidentiality of protected health information (PHI)
- Capability of working independently and as a member of a team
Join our team! If you feel you are the right fit for this role, please apply. We look forward to speaking with you further about working with Asembia.
About Us:
For more than a decade, Asembia has been working with specialty pharmacies, manufacturers, prescribers, and other industry stakeholders to develop solutions for the high-touch specialty pharmaceutical service model.
Asembia focuses on the specialty pharmacy segment and offers comprehensive hub services, pharmacy network management, group purchasing (GPO) services, innovative technology platforms and more.
As a leading industry voice and advocate, Asembia is committed to bringing strategic channel management solutions, leading-edge products and high-touch services to the specialty pharmacy industry that help our customers optimize patient care and outcomes.
Asembia is committed to Equal Employment Opportunity (EEO) and to compliance with all Federal, State and local laws that prohibit employment discrimination on the basis of race, color, age, natural origin, ethnicity, religion, gender, pregnancy, marital status, sexual orientation, gender identity and expression, citizenship, genetic disposition, disability or veteran's status or any other classification protected by State/Federal laws. Asembia
Job Tags
Traineeship, Work experience placement, Local area, Immediate start, Rotating shift, Weekday work,