Job Information
Cleveland Clinic Pharmacy Authorization Representative II in Cleveland, Ohio
Join the Cleveland Clinic team where you will work alongside passionate caregivers and provide patient-first healthcare. You will work alongside dedicated caregivers, receive endless support and appreciation, and build a rewarding career with one of the most respected healthcare organizations in the world.
As a Pharmacy Authorization Representative II, you will ensure optimal reimbursement for high-cost injectable medications and be responsible for conducting, completing and following-up with activities for third party prior authorization requests for high-cost medications.
A caregiver in this role works remotely in Ohio or Florida from 8:00 a.m. - 4:30 p.m.
A caregiver who excels in this role will:
Cross trained to work in all areas of authorizations supporting any institute or facility with minimal leadership guidance.
Act as a resource for training new team members and during the implementation of new processes.
Perform follow-up activities for pending status prior authorizations in accordance with standard operating procedures.
Obtain medical benefit and or pharmacy benefit authorizations via payer portal, by phone or fax.
Retrieve correct clinical information from various sources (i.e. office notes, labs, and other relevant reports) within electronic medical records for submission.
Communicate with providers, clinical caregivers and office caregivers to obtain clinical information and/or coordinate peer-to-peer conversations.
Review payer websites for medication changes and update related to authorization submissions.
Communicate with providers and clinical caregivers to assess medical necessity to support complete authorization submission.
Collaborate with Financial Navigators to assist with Patient Assistance program enrollment.
Facilitate adherence to Medicare requirements including knowledge of Medicare Local Coverage Determinations (LCDs) and Payer Clinical/Medical Policies.
Maintain productivity and quality expectations set forth by department.
Minimum qualifications for the ideal future caregiver include:
High School Diploma or GED and three years of prior authorization and/or pre-certification medication experience, outpatient healthcare experience or other relevant experience
OR Associate's degree or diploma/certificate in medical assisting, medical administrative assisting, billing/coding, or other healthcare related field and two years of prior authorization and/or pre-certification medication experience, outpatient healthcare experience or other relevant experience
Knowledge of medical terminology
Ability to multitask within multiple accounts in high-volume insurance verification processes
Demonstrated PC skills in Word, Excel and Outlook
Preferred qualifications for the ideal future caregiver include:
Experience with third party billing.
Knowledge of ICD-10, HCPCS and CPT codes
Knowledge of healthcare insurance prior authorizations
Physical Requirements:
Sufficient mobility and strength to move around the department and throughout the facility.
Ability to stand or sit for prolonged periods of time.
Excessive walking and standing while obtaining patient information when using laptop computer on wheeled device for bedside registration.
Ability to lift 25 pounds.
Personal Protective Equipment:
- Follows Standard Precautions using personal protective equipment.
Pay Range
Minimum hourly: $16.47
Maximum hourly: $23.61
The pay range displayed on this job posting reflects the anticipated range for new hires. A successful candidate's actual compensation will be determined after taking factors into consideration such as the candidate's work history, experience, skill set and education. The pay range displayed does not include any applicable pay practices (e.g., shift differentials, overtime, etc.). The pay range does not include the value of Cleveland Clinic's benefits package (e.g., healthcare, dental and vision benefits, retirement savings account contributions, etc.).
Cleveland Clinic Health System is pleased to be an equal employment employer: Women / Minorities / Veterans / Individuals with Disabilities