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DATE ADDED: Wed 03/10/2018

Pharmacy Technician - Insurance Verification

Mount Lebanon, USA
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COMPANY: VALEDA HEALTH

Job Description

 POSITION SUMMARY

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.

FUNDEMENTAL COMPONENTS

  • 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. 

 BACKGROUND/EXPERIENCE

  • 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.

 EDUCATION

  • 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

 FUNCTIONAL EXPERIENCE

  • Experience - 1-3 Years

 TECHNOLOGY EXPERIENCE

  • Microsoft Office Suite - 1-3 Years

Company Description
Specialty Pharmacy


Role: Pharmacy Technician - Insurance Verification
Job Type:
Location: Mount Lebanon,

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