Prior Authorization Pharmacy Technician

If you care about the opportunity to grow, to make a difference, to build a future and a life, then we just might have the career for you. Care to talk? Bayhealth Medical Center is Central and Southern Delaware's healthcare leader with hospitals in Dover and Milford, a s well as stand -alone Emergency Department in Smyrna and a hybrid E mergency Department and Urgent Care in Milton . We offer various practice settings throughout Kent and Sussex Counties. Bayhealth Medical Center Kent Campus is 90 minutes from Philadelphia, Washington, DC and Baltimore . Our Sussex Campus is 30 minutes to the Delaware beaches and relaxation in the sand! Bayhealth Medical Center offers a competitive salary and comprehensive benefits package (for eligible positions) including: Generous Paid Time Off and Paid Holidays Matching 401(k)/403(b) Plans Excellent Health, Dental, and Vision Disability and Life Insurance options On Site Child Care Educational Reimbursement Health Care and Dependent Care Flex Spending Accounts Plus, an array of Voluntary Benefits to include Critical Care Coverage and more!

Location:

Kent Campus Hospital Status:

Full Time 80

Hours Shift:

Variable

SALARY RANGE

22.76 - 34.14

HOURLY General Summary:

The Prior Authorization Pharmacy Technician is responsible for maximizing reimbursement through programs that provide funding or provision of specialty drugs, including infusion medications, serving as a liaison between medical practices, infusion clinic teams, and the pharmacy team members, ensuring effective communication regarding insurance prior authorization processes, coordination of patient assistance program information, and education to providers, patients, and staff.

Responsibilities:

1. Identify patient needs and ensure coverage of medication on their insurance plan through benefits investigation. If not covered, obtain necessary information from the medical record, patient, and provider to enable justification for the Patient Assistance program or copay assistance. Contact patients to provide information related to these resources. 2. Provide formulary assistance to medical practices or infusion clinics through evaluating the necessity of prior authorization and identification of formulary alternatives. 3. Obtain initial and renewal insurance authorization for infusion medications as required by insurance plans and provide medication cost estimates. 4. Ensure patients' orders are prescribed to the appropriate pharmacy or location for fulfillment, along with any co-pay assistance documentation. 5. Participate in specialty pharmacy performance improvement programs. Develop a plan to improve, streamline, and increase the efficiency and effectiveness of the prior authorization program. Work with the physician practice and infusion teams to evaluate and further develop systems and processes, including developing a process for tracking prior authorizations and appeals and evaluating Patient Assistance Program software for documentation and tracking applications, renewals, and patient communication, including developing an ROI, budget proposal, and implementation plan. Develop processes for specialty pharmaceutical products needing Risk Evaluation and Mitigation Strategy (REMS) workflows. 6. Serve as the contact individual for revenue cycle inquiries and Patient Assistance audits by providing all necessary documentation: patient financial records, signed applications, original orders, and proof of patient receipt. Assist with assuring resolution of infusion reimbursement and patient assistance issues with patient, provider, third-party payor, and drug manufacturers to ensure patient access to prescribed medications. 7. Serves as a back-up for the Pharmacy Buyer, including ordering and receiving of products, product validations, and product shipping. 8. All other duties as assigned within the scope and range of job responsibilities. Required Education, Credential(s) and

Experience:

Education:

High School Diploma or GED Credential(s):

Certified Pharmacy Technician Experience:

Required:

Three (3) years' experience as a certified pharmacy technician. Preferred Education, Credential(s) and

Experience:

Education:

Associate Degree Credential(s):

Pharmacy Tech Certification Board Billing & Reimbursement Experience:

Preferred:

Five (5) years' experience as a certified pharmacy technician. To view a full list of all open position at Bayhealth, please visit: https://apply.bayhealth.org/join/