The Insurance Verification Technician in a Specialty Pharmacy acts as a resource in the processing of prescription orders, addressing complex and/or escalated issues requiring understanding of the interactions, dependencies and operations of the facility. Functional areas include benefit investigation and prior authorization support.
- Act as a liaison between company, patients, insurance, Pharma, and provider’s office via phone, fax and/or email communication.
- Obtain missing insurance information, diagnosis code and other applicable information by contacting the physician or patient in order to complete the benefits investigation and/or authorization.
- Obtain pharmacy and/or medical benefits via phone, insurance website, or via fax for new and/or existing patients prior to any services rendered.
- Research published insurance coverage criteria and locates authorization forms via payer websites/portals and other applicable avenues.
- Facilitate prior authorization and/or pre-determination as required by the insurance company
- Understands how and when to utilize external authorization systems including insurance and third-party portals.
- Obtain and review clinical documentation (chat notes, labs, testing, etc.) necessary to complete insurance authorizations.
- Initiate authorization, including all available information, based on insurance requirements and completes appropriate follow up to complete pending cases.
- Coordinate with prescribers, nurses, office staff to facilitate insurance authorization requirements
- Communicate the insurance investigation and authorization outcome with physician’s office and/or sales team via fax or email.
- Maintains documentation of calls to and from patients, caregivers, insurance and providers.
- Answer calls and provide assistance as needed to patients, prescribers and internal departments.
- Review inbound faxes and assign to appropriate queues for further action and/or handle as appropriate.
- Document benefit investigation and authorization into the patient care management tool.
- Process prescriptions through the pharmacy dispensing software as required.
- Maintain knowledge of clinical background and insurance requirements for new and emerging therapies
- Maintains patient confidentiality.
- Insures adherence to all DEA, federal, state, and company policies and guidelines.
- Creates and updates physician profiles in pharmacy system including demographics, DEA number, and NPI numbers.
- May insure compliance with aspects of specialty insurance including Medicare and Medicaid.
- May address and resolve insurance rejections to meet payer performance criteria.
- Registered Pharmacy Technician in the state of Pennsylvania is required. Pharmacy Technician Certification is preferred, but not required
- Proficiency in computerized pharmacy systems and software applications required.
- Understanding of medical and pharmacy terminology.
- The highest level of education desired for candidates in this position is a High School diploma, G.E.D. or equivalent experience.
LICENSES AND CERTIFICATIONS
- Pharmacy Technician is desired
- Microsoft Office Suite - 1-3 Years
Role: Pharmacy Technician - Insurance Verification
Location: Mount Lebanon,
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