Pharmacy Medication Auth Tech

The Pharmacy Medication Authorization Technician evaluates and obtains medication authorizations for all patients. This may include authorizations covered under the medical benefit as well as the pharmacy benefit of a health insurance plan. The job may also require patient eligibility and investigation for pharmaceutical medication assistance programs. This job requires the application and interpretation of policies and procedures and the use of independent judgment in a patient care setting. The purpose is to support patients’ access to medications and ensure the minimum loss of revenue and maximum payment for medications. The ability to maintain a working knowledge of carrier contracts and changes as well as departmental policies and procedures is required. The Pharmacy Medication Authorization Technician is able to complete the duties of a general, cross-trained, and specialist pharmacy technician.

• Demonstrates the ability to competently work in general and specialized areas of pharmacy practice.
• Participates in the training of new employees.
• Fills and delivers medications under the supervision of a licensed pharmacist/licensed independent practitioner.
• Policies and procedures are followed consistently.
• Ensures adequate supplies are available for continuous patient care.
• Triages and escalates any questions or issues outside the pharmacy technician scope of practice to the staff pharmacist or supervisor as needed.
• Uses appropriate systems for processing of patient information.
• Ensures quality assurance is maintained according to departmental and legal requirements.
• Operates pharmacy equipment appropriately.
• In addition to the above job responsibilities, other duties may be assigned.

Position Compensation Range: $20.68 - $32.05 Hourly

• Analyzes information required to complete medication authorizations with insurance carriers, service area contacts, and workman’s compensation carriers.
• Accurate and pertinent clinical data and demographics is compiled and communicated to the patients’ insurance company in a timely and organized fashion.
• Medication authorization services are understood and integrated in accordance with Health System and departmental policies and procedures by working collaboratively with designated contacts in service areas.
• Knowledge of insurance company criteria for medication approval is current.
• Authorization approval procedures are communicated to insurance carriers via telephonic/fax/on-line review in an organized and timely fashion.
• Timely follow-up with insurance carriers is performed to obtain certification/authorization documentation for inpatient and outpatient services.
• Demonstrates skill in the proficient use of PC and UVA software systems to ensure that all medication authorization information is entered into required computer systems in an accurate and timely manner. On-line data entry of authorizations and denials are communicated to appropriate personnel. Proficiency in the use of PC and required UVA software systems is appropriately demonstrated. Accuracy and Quality of medication authorization documents are maintained for organized retrieval of patient records. Specific support functions are handled in an organized and timely fashion.
• Demonstrates the skills of effective communication, decision-making, and organization to ensure efficient job performance and job success.
• Daily work is accomplished with minimal direct supervision.
• Work priorities are set in order to accomplish tasks/goals.
• Confidential matters are handled appropriately.
• Familiarity with all relevant insurance plans and formularies is demonstrated.
• Communication with Department billing staff is accomplished in a timely manner to ensure accurate medication authorization information is aligned with accurate billing of services.
• Ability to train staff and to act as a resource to other staff is demonstrated at all relevant times.
• Comprehension of insurance data, benefits, in/out of network issues, notification requirements, and medical diagnosis is consistently demonstrated in order to ensure that all medication authorizations are completed prior to the date of service.
• Sound judgment is consistently demonstrated as to when to involve pharmacists, physicians, or other health care professionals in the medication authorization or denial process.
• Prepares medications for dispensing to patients:
• Receives medications from pharmaceutical manufacturers on behalf of specific patients.
• Enters prescription orders into pharmacy software application for prescription dispensing labeling according to all governing statutes and regulations including pharmacy department policies and procedures.
• After pharmacist checking of prescription and appropriate medicat