Prior Authorization Specialist

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Job Details

Requisition #:665991 Location:Johns Hopkins All Children's Hospital, St. Petersburg, FL 33701 Category:Non-Clinical Professional Schedule:Day Shift Employment Type:Full Time

Make our legacy your legacy. Johns Hopkins All Children's Hospital is a premiere clinical and academic health system, providing expert pediatric care for infants, children and teens with some of the most challenging medical problems. Ranked in multiple specialties by U.S. News & World Report, we provide access to innovative treatments and therapies. With more than half of the 259 beds in our teaching hospital devoted to intensive care level services, we are the regional pediatric referral center for Florida's west coast. Physicians and community hospitals count on us to care for critically ill patients and perform complex surgical procedures.

What Awaits You?

• Career growth and development
• Diverse and collaborative working environment
• Affordable and comprehensive benefits package including Tuition Reimbursement

Position Summary: Under the supervision of case managers and case management leadership, the prior authorization specialist interacts with: pharmacy/medical/clinical staff, revenue cycle staff and family. External interactions include multiple third-party payers, prescription benefit management agencies, governmental peer review organizations, referring physicians and others as applicable. Their relationships are inherent to the success of the position. They are responsible for receiving home medication prescriptions and addressing and resolving rejected claims, completing necessary third party (insurance) prior authorization requests, specialty pharmacy enrollments, verifying prescriptions are filled and patient/families have needed details to obtain their medication at JHACH retail pharmacy, community pharmacies, or specialty/mail order pharmacies. The prior authorization specialist must be highly knowledgeable in the area of third party payor and pharmacy benefit manager agencies, drug formularies, and specialty/mail order/retail pharmacy processes, and hospital systems.

Tour our campus: https://www.youtube.com/watch?v=lKpjrRLZo7c

Hours:

Full-time (40 hours)

Monday - Friday, 8am - 430pm. No Holiday or weekend work requirement.

Location: Johns Hopkins All Children's Hospital, St. Petersburg, FL

Qualifications:

• A minimum of a High School diploma, GED, Certificate of Completion or equivalent achievement.
• 1 year prior experience obtaining prior authorizations
• Must have a Registered Florida Pharmacy Technician License
• PTCP or National Pharmacy Technician Certification preferred but not required Ability to communicate effectively, both verbally and in writing and have good interpersonal skills
• Strong problem solving, critical thinking, organizational and prioritization skills.
• Ability to use computer systems, internet systems, and a variety of computer programs including Microsoft Word, One Note, Outlook email, Teams, PDF conversion platforms, electronic prescription systems, efax technology, hospital systems, Cover My Meds platform, and others as needed.
• Ability to read, speak and understand English
• Knowledge of pharmacy processes, procedures, materials and/or equivalent, mathematics, and medication prescription terminology, and remain current with relative healthcare landscape.

Salary Range: Minimum 17.97/hour - Maximum 28.74/hour. Compensation will be commensurate with equity and experience for roles of similar scope and responsibility. In cases where the range is displayed as a $0 amount, salary discussions will occur during candidate screening calls, before any subsequent compensation discussion is held between the candidate and any hiring authority.

The Hospital reserves the right to modify employee schedules as needed.

We are committed to creating a welcoming and inclusive environment, where we embrace and celebrate our differences, where all employees feel valued, contribute to our mission of serving the community, and engage in equitable healthcare delivery and workforce practices.

Johns Hopkins Health System and its affiliates are drug-free workplace employers.

Johns Hopkins Health System and its affiliates are an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.

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