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Primary responsibility is to work with facility staff to reduce pharmacy non-covered expenses by securing prior authorizations from Medicare Part D providers, state Medicaid plans, and other insurance carriers.
Collaborate with pharmacy staff to identify claims where the insurance provider has rejected the claim for prior authorization-related reasons.
Collect pertinent information from nursing staff, or other means to communicate to insurance carrier.
Communicate to pharmacy staff the status of all worked claims so that rebilling may occur where necessary.
Compile information related to specific pharmacy payer requests regarding prior authorization rejections.
Work pharmacy orders that meet Managed Care plan carve-out requirements to obtain prior authorization approvals.
Is responsible for performing all other duties as assigned.
Attends and participates in scheduled meetings.
Maintains confidentiality of necessary information.
Utilizes supplies and equipment properly and without waste.
Thinks and acts calmly and logically to meet unusual occurrences of the job in a professional manner.
Education: High School diploma or G.E.D. Pharmacy Tech Certification preferred but not required.
Experience: Six months or more with ability to use both Microsoft Excel and Word. Excellent communication and organizational skills.
Physical Demands: Primarily light in nature with lifting less than ten pounds; sitting, reaching, handling, fingering, talking, hearing and seeing.
Travel: 0%
Working Conditions: Inside in well-lighted, well-ventilated areas
Principal Contacts: SNF nursing staff, joint venture partner and provider pharmacies, insurance companies.
General Requirements: Must be able to execute all terms and conditions set forth in the HCR Manor Care Employee Handbook, including, but not limited to:
a. Works in a safety-conscious manner which ensures that safe work practices are used in order not to pose a risk to self or others in the workplace.
b. Complies with company policies and procedures and local, state, and federal regulations.
c. Adheres to policy on Drug Free Workplace.
d. Interacts in a tactful, diplomatic, and humanistic manner with residents, families, visitors, and co-workers to provide a safe, efficient, and therapeutically effective caring environment which ensures the self-respect, personal dignity, rights and physical safety of each resident and center guest.
e. Maintains a dependable attendance record and adheres to standards of cleanliness, grooming, hygiene, and dress code.
f. Takes positive action to ensure equal opportunity in the conduct of all business activities without regard to race, color, religion, sex/gender, age, national origin, disability, citizenship, veteran status or any other legally protected category.
ProMedica is a mission-based, not-for-profit integrated healthcare organization headquartered in Toledo, Ohio. It serves communities in 28 states. The organization offers acute and ambulatory care, an insurance company with a dental plan, and post-acute and academic business lines. The organization has more than 56,000 employees, 13 hospitals, 2,100+ physicians and advanced practice providers with privileges, 900+ healthcare providers employed by ProMedica Physicians, a health plan, and nearly 400 assisted living facilities, skilled nursing and rehabilitation centers, memory care communities, outpatient rehabilitation clinics, and hospice and home health care agencies. Driven by its Mission to improve your health and well-being, ProMedica has been nationally recognized for its advocacy programs and efforts to address social determinants of health. For more information about ProMedica, please visit www.promedica.org/aboutus. Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex, pregnancy, sexual orientation, gender identity or gender expression, age, disability, military or veteran status, height, weight, familial or marital status, or genetics.Equal Opportunity Employer/Drug-Free WorkplaceRequisition ID: 44960
