Description
Promotes the mission and vision of North Country HealthCare (NCHC) by being responsible for providing accurate and complete date input for prescription prior authorization requests and for managing those requests to the point of resolution. This is achieved through collaborative practice and communication with others on the health care team both internal and external to NCHC.

Duties

• Organizes, manages, and completes all prescription prior authorization requests within a reasonable timeframe to ensure a high level of patient care.
• Handles calls from providers, insurance companies, and patients using exemplary customer service skills.
• Accurately enters required information (non-clinical and structured clinical data) into computer database and electronic medical record.
• Reviews structured clinical data matching against specified medical terms and diagnoses or procedure codes (without need for interpretation) and follows established procedures for completion of requests.
• Informs provider(s) when results of prior authorization are determined per established procedures.
• Calls pharmacies with authorization numbers/authorization information when it becomes available.
• Follows-up with any outstanding prior authorizations on a regular basis.
• Manages vendor portal to ensure correct routing of prior authorization requests.
• Establishes and maintains documentation of prior authorization processes including EMR documentation.
• Maintains patient confidentiality as defined by state, federal and organizational regulations.
• Establishes effective rapport with other employees from outlying clinics and maintains strong communication links with those employees.

Requirements

• High School diploma or GED.
• BLS (with in-person component) required upon hire.
• Certified Pharmacy Technician (CPhT) or other health professional training [examples include Medical Assisting (MA) certification or a Licensed Practical Nurse (LPN)] and Pharmacy Technician Certification Board (PTCB) or equivalent professional licensure required upon hire.
• Bachelor's degree in related field preferred.
• 1 year experience with prescription prior authorization processing or retail pharmacy preferred.

Compensation
Starting at $21.63/hr+ DOE