Pharmacy Prior Auth Specialist

WHO WE ARE & WHAT WE DO

Tallahassee Memorial Healthcare (TMH) is a private, nonprofit community-based healthcare system that provides care to a 22-county region in North Florida and South Georgia. We are a career destination with over 6,000 colleagues who reflect the diversity of our community. TMH is the region's healthcare leader and top provider of advanced care with a 772-bed acute care hospital and the region's only:

• Level II Trauma Center 
• Primary Stroke Center 
• Level III Neonatal Intensive Care 
• Pediatric Intensive Care 
• The most advanced cancer, heart and vascular, orthopedic & surgery programs in the Panhandle. 

Our system also includes a psychiatric hospital, multiple specialty care centers, six residency programs and more than 50 affiliated physician practices. 

HOW YOU'LL MAKE AN IMPACT

Your Role:

• Verifies eligibility, obtains insurance benefits, and ensures pre-certification, authorization, and referral requirements are met prior to medication delivery.

• Utilizes a proactive approach to ensure timely approvals facilitating high-quality patient care.

• Manages prior authorizations and supports the 340B Drug Pricing Program.

• Maintains documents and records.

• Audits documents to ensure regulatory compliance.

• Collaborates with healthcare providers, physicians, and clinical staff members.

Reports To:  

• Prog/Specialty Pharm Mgr 340B 

Supervises:  

• None 

WHAT YOU’LL NEED TO APPLY

Required Education:

• High school diploma or equivalent (e.g., certificate of high school equivalency).

Preferred Education:

• Associate degree in Healthcare Administration, Business Administration, or other Healthcare field. 

Required Experience:

• Two (2) years of Healthcare, Medical Billing, or related experience.

Preferred Experience: 

• Retail of Specialty Pharmacy experience.

Required Certification/License/Registry:

• Prior Authorization Certified Specialist (PACS) credential from the Accreditation Council for Medical Affairs (ACMA) within six (6) months post-hire.

• Certified Pharmacy Technician (CPhT) credential from the Pharmacy Technician Certification Board (PTCB) or the National Healthcareer Association (NHA) within (6) months post-hire.

Preferred Certification/License/Registry:

• 340B Operations Certificate issued by Apexus.

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Tallahassee Memorial HealthCare is an equal opportunity employer and drug-free workplace. All employment is contingent upon successful completion of a drug screen, background check, reference verification, health assessment, and credential/license verification.