COVID vaccine will be required unless medical / religious exemption. Seeking a Biologics/Medications Prior Authorization Coordinator for our Pediatric Specialty Office in Vahalla, NY. The hours are Monday – Friday 8:30am – 4:30pm. Pay rate is $22 - $24/hr.

Essential Job Functions:

• Works effectively with insurance companies to get all biologic drugs and other medications approved.
• Pre-Authorization initiated same business day.
• Communicates effectively with physicians and clinical staff on the status of the Pre-authorization.
• Communicates with patient(s) if there are difficulties obtaining prior authorizations or determining eligibility.
• Reading insurance clinical guidelines to ensure the biologic meets clinical guidelines and the patient has completed appropriate step-therapy.
• Communicates with the pharmacies on patient(s) prior authorization approvals.
• Uses the EHR system to document the pre-authorization approval or denial. Follows up with staff and/or physicians accordingly.
• Works with CoverMyMeds daily and can maneuver the website effectively.
• Uses website portals to obtain benefits and submit pre-authorization, when applicable.
• Communicates effectively with other staff at outside facilities and home care agencies where infusions take place.
• Understands patient assistance programs and free drug programs and can assist patients in signing up.
• Can maneuver through the EHR to find the needed medical information.
• Documents appropriately in the EHR.
• Takes personal responsibility for their work and fosters teamwork.
• Maintains confidentiality of patient records.
• Communicates with patient and staff regarding patient assistance programs for medications.
• Other duties as assigned

Qualifications/ Education and Experience:

• Prior Authorization experience required
• Biologic experience preferred
• Bilingual Spanish preferred
• Certified Medical Assistant experience preferred
• 2 or more years experience in the medical field
• Knowledge of ICD-10 and CPT codes needed for authorization and coverage purposes.
• Knowledge of insurance terminology (i.e. Deductible, Co-Insurance, Out-of-pocket max, ext).
• Excellent communication skills
• Excellent computer skills