Fairview Health Services Prior Authorization Specialist in Minneapolis, Minnesota

Overview

The Prior Authorization Specialist is responsible for verifying health insurance, obtaining benefits and meeting payer requirements to secure prior authorizations for medications. Verifies insurance coverage, resolves any issues with authorization and escalates complicated issues to appropriate manager. Prior Authorization Specialist acts as a liaison between patients, their health insurance, and care providers to assist in the understanding of their pharmacy benefit and responsibility.

Responsibilities/Job Description

Using strong knowledge of insurance, clinic operating procedures and pharmacy operations, this position will:

  • Ensure timely response and initiation of prior authorization requests, consulting patient record and other resources as needed.

  • Document patient information in the medical record using standard operating procedures and meeting appropriate timelines.

  • Drive communication with clinic staff, patients, third party payers and dispensing pharmacy to provide exemplary customer experience and ensure all payer requirements are met

  • Provide superior customer service to all internal and external customers.

  • Serve as a prior authorization resource to the affiliations, staff and physicians regarding Fairview Pharmacy services. Assist with coordination of services by communicating effectively and in a timely manner with others.

Qualifications

Experience

One year of experience in a pharmacy setting or with revenue cycle, health insurance or benefits

Preferred Experience & Qualifications:

2 years of experience in a pharmacy setting or with revenue cycle, health insurance or benefit experience using ICD 10 Codes.

Registered Technician with Minnesota Board of Pharmacy

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Fairview Health Services (fairview.org) is an award-winning, nonprofit health system providing exceptional care across the full spectrum of health care services. Joined by HealthEast in June 2017, Fairview is one of the most comprehensive and geographically accessible systems in the state, with 12 hospitals—including an academic medical center and long-term care hospital—serving the greater Twin Cities metro area and north-central Minnesota.

Its broad continuum also includes 56 primary care clinics, specialty clinics, senior living communities, retail and specialty pharmacies, pharmacy benefit management services, rehabilitation centers, counseling and home health care services, medical transportation, an integrated provider network and health insurer PreferredOne. In partnership with the University of Minnesota, Fairview’s 32,000 employees and 2,400 affiliated providers embrace innovation to drive a healthier future through healing, discovery and education.

EEO/AA Employer/Vet/DisabledAll qualified applicants will receive consideration without regard to any lawfully protected status.

Requisition ID 2018-27565

Profession Non-Clinical Support Staff

Speciality Pharmacy

Location Fairview offices at Kasota

Shift day

Hours per 2 weeks 80

Department Pharmacy - Univ Cam