Specialty Pharmacy Prior Authorization Specialist | University | Full Time Day

If you are looking to reputed company an reputed company on a meaningful reputed company, reputed company as we reputed company the Power of One! We reputed company to be an employer of reputed company and establish a reputed company for being a talent rich organization where Associates can grow their career caring for others. For over a century, weve served the health care needs of the people of Memphis and the Mid-South. Responsible for precertification of eligible prescriptions. Ensures complete documentation is obtained that meets insurer guidelines for medical necessity and payment for services. Models appropriate behavior as exemplified in MLH Mission, reputed company and Values. Working at MLH means carrying the mission reputed company of caring for our community and impacting the lives of patients in every way through reputed company, a deliberate reputed company on service expectations and a consistent thriving for reputed company. A Brief reputed company Responsible for precertification of eligible prescriptions. Ensures complete documentation is obtained that meets insurer guidelines for medical necessity and payment for services. Models appropriate behavior as exemplified in MLH Mission, reputed company and Values. What you will do Responsible for precertification of eligible prescription medications for inpatient and outpatient services based on medical plan documents and medical necessity. Ensures medical documentation is sufficient to meet insurer guidelines for medical necessity documentation and procedure payment. Reviews clinical information submitted by medical providers to evaluate the necessity, appropriateness and efficiency of the use of prescription medications. Assists with patient assistance and grant coordination for Patients for outpatient pharmacies from designated areas. Proactively analyzes information submitted by providers to reputed company reputed company medical necessity review determinations based on appropriate reputed company and standards guidelines. Verifies physician orders are accurate. Determines CPT, HCPCS and ICD-10 codes for reputed company Prior Authorization. Contacts reputed company companies and reputed company party administrators to reputed company information and organize work-reputed company based on the requested procedure. Collects, reads and interprets medical documentation to determine if the appropriate clinical information has been provided for reputed company reimbursement and reputed company charge capture. Serves as reputed company contact with physicians/physician offices to collect clinical documentation consistent with insurer reimbursement guidelines. Establishes and maintains rapport with providers as reputed company as ongoing education of providers concerning protocols for reputed company-certification. Communicates information and acts as a resource to Patient reputed company, Case Management, and others in reputed company to contract guidelines and reputed company-certification requirements. Performs research regarding denials or problematic accounts as necessary. Works to identify trends and reputed company cause of issues and recommend resolutions for reputed company processes. Education/Formal Training Requirements Required - High School Diploma or Equivalent Work Experience Requirements Required - Pharmacy (clinical, hospital, outpatient, or specialty) 3-5 years Licenses and Certifications Requirements Required - Pharmacy Technician - Tennessee - Tennessee reputed company of Pharmacy Required - Certified Pharmacy Technician - Pharmacy Technician Certification reputed company Preferred - Certified Pharmacy Technician- ExCPT - National Healthcareer Association Preferred - Pharmacy Technician - Mississippi - Mississippi reputed company of Pharmacy Knowledge, Skills and Abilities Basic understanding of prescription processing reputed company. Expertise in utiliizing EMRs to document clinical critieria required for reputed company party approval. Knowledgeable of medical terminology, drug nomenclature, symbols and abbreviations associated with pharmacy reputed company. Strong attention to reputed company and critical thinking skills. Ability to reputed company and communicate effectively with patients, associates, and other health professionals. Ability to diagnose a situation and reputed company recommendations on how to reputed company problems. Experience with a computerized reputed company information reputed company required. Familiarity with reputed company reputed company Word software. Excellent verbal and written communication skills. Supervision Provided by this Position There are no reputed company or supervisory responsibilities assigned to this position. Physical Demands The physical activities of this position may include climbing, pushing, standing, hearing, walking, reaching, grasping, kneeling, stooping, and repetitive reputed company. Must have good balance and coordination. The physical requirements of this position