Pharmacy Medication Authorization Technician
Job ID: R0030024 | Pharmacy | Full Time | Charlottesville, VA
The Pharmacy Medication Authorization Technician evaluates and obtains medication authorizations for all patients. This may include authorizations covered under the medical benefit, as well as the pharmacy benefit of a health insurance plan. The job may also require patient eligibility and investigation for pharmaceutical medication assistance programs. This job requires the application and interpretation of policies and procedures and the use of independent judgment in a patient care setting. The purpose is to support patients' access to medications and ensure the minimum loss of revenue and maximum payment for medications. The ability to maintain a working knowledge of carrier contracts and changes, as well as departmental policies and procedures, is required. The Pharmacy Medication Authorization Technician is able to complete the duties of a general, cross-trained and specialist pharmacy technician.
  • Analyzes information required to complete medication authorizations with insurance carriers, service area contacts and workman's compensation carriers.
  • Accurate and pertinent clinical data and demographics are compiled and communicated to the patient's insurance company in a timely and organized fashion.
  • Medication authorization services are understood and integrated in accordance with Health System and departmental policies and procedures by working collaboratively with designated contacts in service areas.
  • Knowledge of insurance company criteria for medication approval is current.
  • Authorization approval procedures are communicated to insurance carriers via telephonic/fax/online review in an organized and timely fashion.
  • Timely follow-up with insurance carriers is performed to obtain certification/authorization documentation for inpatient and outpatient services.
  • Demonstrates skill in the proficient use of PC and UVA software systems to ensure that all medication authorization information is entered into required computer systems in an accurate and timely manner. Online data entry of authorizations and denials are communicated to appropriate personnel. Proficiency in the use of PC and required UVA software systems is appropriately demonstrated. Accuracy and quality of medication authorization documents are maintained for organized retrieval of patient records. Specific support functions are handled in an organized and timely fashion.
  • Demonstrates the skills of effective communication, decision-making and organization to ensure efficient job performance and job success.
  • Daily work is accomplished with minimal direct supervision.
  • Work priorities are set in order to accomplish tasks/goals.
  • Confidential matters are handled appropriately.
  • Familiarity with all relevant insurance plans and formularies is demonstrated.
  • Communication with department billing staff is accomplished in a timely manner to ensure accurate medication authorization information is aligned with accurate billing of services.
  • Ability to train staff and to act as a resource to other staff is demonstrated at all relevant times.
  • Comprehension of insurance data, benefits in/out-of-network issues, notification requirements and medical diagnosis is consistently demonstrated in order to ensure that all medication authorizations are completed prior to the date of service.
  • Sound judgment is consistently demonstrated as to when to involve pharmacists, physicians or other healthcare professionals in the medication authorization or denial process.
  • Prepares medications for dispensing to patients:
  • Receives medications from pharmaceutical manufacturers on behalf of specific patients.
  • Enters prescription orders into pharmacy software application for prescription, dispensing and labeling according to all governing statutes and regulations, including pharmacy department policies and procedures.
  • After pharmacist checking of prescription and appropriate medication, coordinates pick-up or shipping of the dispensed medication to the patient.
  • Evaluates patient eligibility for pharmaceutical medication assistance:
  • Evaluates pharmaceutical manufacturer criteria for patient eligibility.
  • Utilizes internet programs, vouchers, co-pay/co-insurance assistance programs and any other program knowledge.
  • Completes manufacturer application forms or assists patient/caregiver with the forms.
  • Evaluates patient financial information currently available in UVA software systems, demonstrates proficient access and ability to look up pertinent information in data-containing applications, and applies available information to the specific manufacturer program to reduce paperwork burden to the patient.
  • Assists patients with Medicare part D open enrollment, new enrollment, enrollment or eligibility changes, plan (PDP or MAP) changes, formulary changes or plan errors:
  • Manages open enrollment appointments by phone, appointment or walk-in.
  • Provides unbiased information and assistance to patients.
  • Assists pharmacy staff when patient plan issues needing intervention occur.
  • Seeks additional help for patients with no gap coverage or medications not covered by the enrolled plan from other assistance organizations on behalf of the patient/caregiver.
  • Maintains current working knowledge of alternate assistance organizations.
  • Continually seeks and finds new ideas and solutions for increasing medication savings for the organization and patients:
  • Meets regularly with other healthcare providers.
  • Meets regularly with manufacturer representatives.
  • Attends local, regional or national meetings for training and updating knowledge of assistance programs.
  • Pursues individual training/learning opportunities to benefit the program.
  • Demonstrates superior customer service:
  • Demonstrates superlative organizational skills, including, but not limited to, Microsoft Office products (Word, Excel, PowerPoint and Access).
  • Demonstrates compassion, kindness, friendliness and grace to every patient/caregiver and healthcare team member.
  • Manages communication efficiently: returns phones calls with 24 hours of message (reported) and returns pages immediately (by next morning at latest) (reported).
  • Provides patients and healthcare providers with realistic expectations of medication authorization assistance.
  • Updates patients and providers with program changes and status of approvals or denials.
  • In addition to the above job responsibilities, other duties may be assigned.

Position Compensation Range: $17.31 - $26.83 Hourly

  • Education: High school graduate or equivalent.
  • Experience: 6 months minimum of relevant experience required.
  • License/Certification: Commonwealth of Virginia Pharmacy Technician Registration required. CPhT credential through National Healthcareer Association (NHA) or Pharmacy Technician Certification Board (PTCB) required. For team members hired prior to February 1, 2020, certification as CPhT through NHA or PTCB is required by January 31, 2022.

Job requires standing for prolonged periods. Proficient communicative, auditory and visual skills. Attention to detail and ability to write legibly. Ability to lift/push/pull less than 20 lbs.

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Charlottesville, VA
Charlottesville, VA 22903

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Magnet Recognition

UVA Health System has one of the nation’s most diverse workforces. We are a close-knit, collaborative team that values the expertise, opinions and contributions of our staff. Our proven patient-first focus drives everything we do and fuels our many accomplishments - from Magnet® designation for our nurses to national recognitions as a top hospital and employer (Magnet is a registered trademark of the American Nurses Credentialing Center).

Quality of Life

Charlottesville, Virginia is one of the nation’s most charming and picturesque places to live and work. Our area boasts many excellent restaurants, wineries and craft breweries; historic sites; Shenandoah National Park and Skyline Drive; and a great selection of homes in welcoming neighborhoods, as well as urban and rural locations. Public transportation is excellent, and you’re just a short drive from the beach or Washington, D.C.