Medication Prior Authorization Specialist
St. Luke's University Health Network
- Allentown, PA
- 3 days ago
Highlights
Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care. Utilizes online, fax, and telephony pathways to obtain prior authorizations from insurance companies for prescribed medications and documents medication prior authorizations in the medical record as necessary.
Numbers & Facts
| Location | Allentown, PA |
| Industry | Healthcare Services |
| Company Size | 5,000 to 9,999 employees |
Description
St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care.
The Medication Prior Authorization Specialist is responsible for the coordination of insurance prior authorizations for applicable patient prescriptions. This role liaises with providers, insurance companies, and patients to perform insurance verification, obtain prior authorizations, and bring the authorization process to resolution.
JOB DUTIES AND RESPONSIBILITIES:
- Monitors prior authorization work queues WQ(s) and promptly obtains and/or reviews patient insurance information and eligibility verification required to secure medication prior authorizations.
- Utilizes online, fax, and telephony pathways to obtain prior authorizations from insurance companies for prescribed medications and documents medication prior authorizations in the medical record as necessary.
- Seeks additional information and/or communicates updates to patients and providers as appropriate throughout the prior authorization process.
- Engages insurance company representatives and provides required clinical information to secure prior authorization, when necessary.
- Engages practice operations and incorporates clinical care team when prior authorization attempt is unsuccessful and/or a peer-to-peer and/or alternative medication is required.
- Escalates complex prior authorization issues to Supervisor, Medication Prior Authorization for assistance/guidance.
- Maintains working knowledge of St. Luke's electronic medical record system, internal systems and tools, and other online insurance websites.
- Maintains solution-oriented/creative mindset to effectively anticipate and tend to patient needs by partnering with other organizational team members/departments.
- Actively participates in performance improvement and continuous quality improvement activities.
- Other related duties as assigned.
PHYSICAL AND SENSORY REQUIREMENTS:
Sitting for up to 8 hours per day, 3 hours at a time. Consistent use of hands and fingers for typing, telephones, data entry, etc. Occasional twisting and turning. Uses upper extremities to lift and carry up to 15 pounds. Stoops, bends, and reaches above shoulder level to retrieve files. Hearing as it relates to normal conversation. Seeing as it relates to general vision. Visual monotony when reading reports and reviewing computer screen.
EDUCATION:
- High School graduate or equivalent.
TRAINING AND EXPERIENCE:
Required:
- One year practice-based experience or in a similar healthcare setting.
Preferred:
- Customer service experience.
- Previous prior authorization experience.
- Previous Medical Assistant experience.
Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!!
St. Luke's University Health Network is an Equal Opportunity Employer.
About Company
St. Luke's University Health Network is a regional network of hospitals, physicians and other related organizations providing care primarily in Lehigh, Northampton, Monroe, Carbon, Schuylkill, Bucks, Montgomery and Berks counties in Pennsylvania and Warren County in New Jersey.
The Network provides services at more than 150 sites. St. Luke's University Health Network is comprised of six hospital sites. The Network includes:
- More than 80 owned physician-practice sites
- 300 employed primary care/specialist physicians
- Various outpatient testing and service facilities
- Home health
- Hospice services (inpatient and outpatient)
- Largest ambulance provider in Bucks County and second largest in Lehigh County
- Other related organizations
- 57,500+ annual admissions
- 195,000 annual emergency room visits
- 1,325 physicians on the Medical Staff (96 percent board-certified)
- 8,600+ employees
- More than 1,350 volunteers
Areas of exceptional medical expertise include:
- Level 1 Adult Trauma Center: fully accredited by Pennsylvania Trauma Systems Foundation; 2,400+ annual trauma cases; St. Luke's 1.75 percent mortality rate represents top decile performance, significantly better than peer group as measured by National Trauma Data Bank of the American College of Surgeons; aeromedical transport services
- Oncology: first and only cancer program in Pennsylvania to receive American College of Surgeons' highest quality recognition for three consecutive years; only Pennsylvania program to receive award in 2010; region's only fellowship-trained surgical oncologists; advanced programs for melanoma (internationally recognized melanoma investigator), lung, breast, prostate, gynecologic and gastrointestinal cancers and tumors of the brain and spine
- Cardiology and Cardiovascular Surgery: multiple-year recipient of highest rating for cardiac bypass surgery, represents top decile performance achieved by only 10 percent of U.S. hospitals (Society for Thoracic Surgery); region's first Joint Commission certified Heart Failure Program; comprehensive surgical services excluding heart transplants
- Neuroscience: accredited Stroke Center; additional Centers of Excellence include: Balance Center, Headache Center, Memory Disorders Center, Multiple Sclerosis Center, Sleep Disorders Center
- Orthopaedics: advanced expertise in total joint replacement and reconstruction, computer-assisted minimally invasive surgery, primary and reconstructive surgery of the spine, sports injuries, diseases and conditions of the hand and elbow, traumatic injuries
- Women's/Children's Health: high-risk pregnancy; the region’s busiest obstetrical service; two neonatal intensive care units; pediatric specialty care provided by St. Christopher's Hospital for Children.
- Robotic/Minimally Invasive Surgery: one of the nation's most experienced robotic surgical teams
- Radiology: designated international General Electric Healthcare Show Site for imaging technology; designated Breast Imaging Center of Excellence by American College of Radiology
- Bariatric Surgery: designated Center of Excellence by American Society for Metabolic and Bariatric Surgery and Surgical Review Corporation
St. Luke's offers an exceptional benefit plan for employees. Our values are reflected in all we do for patients, each other and the community:
Pride - We take pride in our accomplishments and in our organization.
Caring - We show consideration for others and their feelings. We treat others as we want to be treated.
Respect - We recognize the value, diversity and importance of each other, those we serve and the organization.
Accountability - We are responsible to make decisions and solve problems in a timely and effective manner.
Flexibility - We adapt to the changing needs and expectations of those we serve.
Teamwork - We work together to improve quality.
The mission of St. Luke's University Health Network is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care.