Job Summary

Accountable to obtain prior authorization for medications. Complete benefit investigation to determine coverage for prescribed treatment and act as a liaison for all medication prior authorization matters to insurance companies, departments, and patients. Act as subject matter expert for patient medication assistance foundations, free drug and drug replacement programs for uninsured, under-insured, indigent population. Maintains updated knowledge of pharmacy reimbursement methodologies.

Job Duties

· Completes prior authorization and documents referrals for all medications reviewed using appropriate third-party payer criteria.

· Conducts research and follow-up activities within established timeframes. Maintains knowledge of criteria changes of third-party payor authorization requirements.

· Communicates with care team to provide details on authorization status.

· Maintains knowledge of all available patient assistance programs and eligibility requirements.

· Identifies available appropriate medication assistance programs upon discussing with patient the affordability of the prescribed treatment.

· Ensures accurate completion necessary signatures of appropriate paperwork for enrollment in assistance program(s).

·Tracks fund award end dates and exhaustion, re-apply as necessary to avoid lapse in therapies.

·Communicates with care team to provide details on status of assistance applications.

·Educate providers and patients on specialty services and how this improves overall patient care. Grow the specialty pharmacy’s patient population.

· Floats from areas of low workload to areas of heavy workload as needed to provide optional patient services.

· Accountable for satisfying all job specific obligations and complying with all organization policies and procedures.

Education

High School Diploma or Equivalent (GED)- (Required)

Experience

Minimum of 2 years-Related work experience (Required)

Skills

Communication; Workplace Organization; Computer Literacy; Customer Service; Healthcare Industry; Medical Terminology

About Geisinger

Founded more than 100 years ago by Abigail Geisinger, the system now includes ten hospital campuses, a 550,000-member health plan, two research centers and the Geisinger Commonwealth School of Medicine. With nearly 24,000 employees and more than 1,700 employed physicians, Geisinger boosts its hometown economies in Pennsylvania by billions of dollars annually. Learn more at geisinger.org or connect with us on Facebook, Instagram, LinkedIn and Twitter.

Equal Opportunity Employer

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws.

Our Vision & Values

Everything we do is about making better health easier for our patients, our members, our students, our Geisinger family and our communities.

KINDNESS: We strive to treat everyone as we would hope to be treated ourselves.

EXCELLENCE: We treasure colleagues who humbly strive for excellence.

LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow.

INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation.

SAFETY: We provide a safe environment for our patients and members and the Geisinger family.

Our Benefits

We offer healthcare benefits for full time and part time positions from day one, including vision, dental and prescription coverage.